Title X and Barriers to Insurance Use for Confidential Family Planning Services

Title X-funded health centers’ ability to bill patients’ health insurance for confidential family planning and reproductive health services remains limited even as more of their patients have gained coverage under the Affordable Care Act (ACA), according to a new journal article.  The article describes a new study by researchers at George Washington University Milken Institute School of Public Health (Milken Institute SPH) and the National Family Planning & Reproductive Health Association (NFPRHA) that provides important new insights into how the health centers navigate barriers to insurance use while maintaining confidentiality. 

“Title X-funded health centers have played a critical role in ensuring access to a broad range of family planning and related preventive health services for millions of low-income or uninsured individuals for more than 40 years,” says Assistant Professor Leah Masselink of the Milken Institute SPH’s Department of Health Policy and Management. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. 

Even though the number of patients at Title X-funded health centers who have health insurance has grown under the ACA, billing some patients’ insurance for services can be difficult because of Title X’s extensive confidentiality protections. “Little has been known about health centers’ experiences in addressing these difficulties,” says Milken Institute SPH Professor Susan Wood, who is also in the Department of Health Policy and Management.   

The new article presents findings from focus groups conducted with Title X-funded health center staff members and state program administrators as part of Confidential & Covered, a three-year study of confidentiality and insurance billing practices in Title X-funded health centers funded by the Office of Population Affairs and conducted in collaboration with NFPRHA and the Bixby Center for Global Reproductive Health at the University of California, San Francisco. Milken Institute SPH MPH-Health Policy alumna Julie Lewis, former policy director at NFPRHA, and Clare Coleman, president and CEO of NFPRHA, were coauthors on the article.

The analysis identified five key barriers to centers’ ability to bill patients’ health insurance. Insurance providers’ policyholder communications (e.g., explanations of benefits or patient portal postings) can threaten confidentiality for patients insured as dependents. The addition of new insurance options under the ACA has caused confusion for patients and providers about insurance coverage and confidentiality protections, and health centers are hesitant to bill insurance when protections are unclear. Changes in Medicaid family planning waiver coverage in some states have added to this uncertainty. Health centers can encounter significant administrative burdens when billing insurance while trying to protect patients’ confidentiality. Finally, patients sometimes hesitate to use their insurance because of financial or other concerns.

Title X-Funded Health Center Staff Members’ Perspective on Barriers to Insurance Use for Confidential Family Planning Services” is published in Perspectives on Sexual and Reproductive Health.