Beyond the Numbers: Access to Reproductive Health Care for Low-Income Women in Five Communities

Executive Summary
  1. Wisconsin covers adults up to 100% FPL in Medicaid but did not adopt the ACA Medicaid expansion.

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  2. Missouri’s Women’s Health Services Program covers family planning services and approved methods of contraception to uninsured women ages 18-55 with income up to 201% FPL. The program does not permit payments to family planning providers if they also provide abortion services.

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  3. Abstinence Plus models typically stress abstinence, but also include information on contraception and condoms.

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  4. FLASH is a widely used, comprehensive sexuality education curriculum developed by Public Health Seattle–King County and intended to prevent teen pregnancy, sexually transmitted infections and sexual violence. More information is available at https://www.etr.org/flash/.

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  5. In 2019, the state legislatures in Alabama and Missouri passed laws that would have effectively banned abortion services in those states. Federal court rulings have temporarily blocked the enactment of those laws; the states are appealing those rulings.

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Dallas County (Selma), AL
  1. 2013-2017 American Community Survey 5-Year Estimates.

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  2. Established through a waiver agreement between Alabama and the federal government.

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  3. 2013-2017 American Community Survey 5-Year Estimates.

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  4. Healthy Horizons magazine, 2018.

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Tulare County, CA
  1. This reflects the highest eligibility limit for pregnant women in the state under the CHIP program’s “unborn child” option. California Medicaid’s pregnancy eligibility limit is 213% FPL.

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  2. HIV/AIDS cases reported by year, preliminary 2018 data, Tulare County, HHSA Public Health.

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St. Louis, MO
  1. St. Louis County, which encompasses all the suburban municipalities, is separate from the adjacent but independent St. Louis City.

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  2. This reflects the highest eligibility limit for pregnant women in the state under the CHIP program’s “unborn child” option. Missouri Medicaid’s pregnancy eligibility limit is 201% FPL.

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  3. As of November 2019, this ruling has not had an immediate effect and the state is expected to appeal.

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  4. On June 20, 2019, a panel of federal appeals court judges ruled that parts of the Title X rule, such as the ban on abortion referrals, would go into effect immediately, with physical separation requirements going into effect in March 2020.

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  5. The largest hospital in the city provides abortions in cases of health complications and fetal anomalies.

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  6. PPSLR and the state of Missouri are involved in a legal battle over their licensure. The case was heard by an Administrative Hearing Commission in October 2019. If the panel sides with the state, Missouri could become the first state without an abortion clinic.

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  7. Section 330 of the Public Health Service Act defines federal grant funding opportunities for organizations, such as community health centers, to provide care to underserved populations.

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Crow Tribal Reservation, MT
  1. Montana’s Medicaid expansion program, HELP, covers adults with incomes up to 138% FPL, and the Plan First family planning Medicaid waiver covers women ages 18-44 with incomes up to 216% FPL. Also, pregnant women with incomes up to 162% FPL are eligible for Medicaid, with coverage extending 60 days postpartum.

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  2. For more information about the history of midwifery among Native American women, see Theobald, B. Reproduction on the Reservation.

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  3. Lawrence, J. (2000). The Indian Health Service and the Sterilization of Native American Women. American Indian Quarterly 24(3). Retrieved from http://bixby.ucla.edu/journal_club/Lawrence_s2.pdf.

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  4. Jaimes, M. A. (1992). The State of Native America: Genocide, Colonization, and Resistance. Boston, MA: South End Press.

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  5. Theobald, B. (2019). Reproduction on the Reservation. Pregnancy, Childbirth, and Colonialism in the Long Twentieth Century. Chapel Hill, NC: The University of North Carolina Press.

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Erie County, PA
  1. FLASH is a comprehensive sexuality education curriculum developed by Public Health Seattle–King County and intended to prevent teen pregnancy, sexually transmitted infections and sexual violence. It is widely used and includes curricula for elementary, middle, and high school and special education classrooms. More information is available at https://www.etr.org/flash/.

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  2. Saint Vincent Hospital merged with Allegheny Health Network, operated by the insurer Highmark.

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  3. Kaiser Family Foundation analysis of Department of State Worldwide Refugee Admissions Processing System, 2012-2018. Accessed October 2019.

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  4. After Pennsylvania’s Medicaid expansion, adults at or below 138% of the federal poverty level are eligible for Medicaid. Pregnant women are eligible for Medicaid up to 220% FPL.

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