Working Paper: NBER ID: w13045
Authors: Melissa S. Kearney; Phillip B. Levine
Abstract: This paper examines the impact of recent state-level Medicaid policy changes that expanded eligibility for family planning services to higher income women and to Medicaid clients whose benefits would expire otherwise. We begin by establishing that the income-based policy change led to a substantial increase in the number of program recipients. We then examine Vital Statistics birth data from 1990 to 2003 and determine that it also reduced overall births to non-teens by about two percent and to teens by over four percent. Our estimates suggest a nearly nine percent reduction in births to women age 20-44 made eligible by the policy change. We supplement our state-level analysis with an investigation of individual-level data from the 1988, 1995, and 2002 National Surveys of Family Growth (NSFG) to examine the impact of these policies on sexual behavior and contraceptive use. Evidence from this analysis suggests that the reduction in fertility associated with raising income thresholds for eligibility was accomplished via greater use of contraception. Our calculations indicate that allowing higher income women to receive federally-funded family planning cost on the order of $6,800 for each averted birth.
Keywords: family planning; Medicaid policy; fertility; contraceptive use; unintended pregnancies
JEL Codes: I18; J13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Greater contraceptive use (J13) | Reduction in fertility rates (J13) |
| Medicaid family planning waivers (I18) | No significant evidence of increased sexual activity (J12) |
| Expansion of eligibility for family planning services through income-based waivers (I38) | Increase in the number of women receiving family planning services (J13) |
| Increase in the number of women receiving family planning services (J13) | Reduction in overall births (J13) |
| Increase in the number of women receiving family planning services (J13) | Reduction in births among women aged 20-44 (J13) |
| Medicaid family planning waivers (I18) | Increase in Medicaid family planning service recipients (J13) |