Contraceptive use among Medicaid-covered teens and risk of teen conception: a longitudinal study

To investigate Medicaid-covered teens' receipt of physician-prescribed contraceptives and the impact of this receipt on pregnancy rates before and after welfare reform and the expansion of children's public health insurance in the late 1990s. Contraceptive prescriptions and pregnancy events were identified from Medicaid claims for two 24-month periods (January 1, 1994-December 31, 1995, and January 1, 2000-December 31, 2001). Participants were all female Medicaid beneficiaries aged 15-19 enrolled anytime in the two 24-month periods, excluding teens pregnant within the first 3 months of enrollment, with incomplete enrollment data or undocumented immigration status, enrolled in a capitated Medicaid plan, or with other concurrent health coverage. We used a discrete-time hazard model to examine the association between paid contraceptive prescriptions and other variables and conception in Florida and Georgia. Receipt of physician-prescribed contraceptives increased from 11% to 18% among Florida teens and from 22% to 27% among Georgia teens during the study period. Georgia teens receiving contraceptive prescriptions were 45% less likely to conceive than teens with no contraceptive prescriptions in 1994-1995 and 64% less likely in 2000-2001. In Florida, teens receiving contraceptive prescriptions were one third less likely to conceive than teens with no contraceptive prescriptions in both 1994-1995 and 2000-2001. An increase in the receipt of contraceptive prescriptions paid by Medicaid may help in reducing pregnancies among low-income teens.