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TAKE CHARGE

Interim Evaluation

Summary

Washington State's TAKE CHARGE program, which began July 2001, expands Medicaid coverage for family planning services to men and women with family incomes at or below 200% of the federal poverty level (FPL). Program goals are to improve the health of women, children and families in Washington by reducing unintended pregnancies and lengthening intervals between births, and to reduce state and federal Medicaid expenditures for births from unintended pregnancies and their associated costs. The Medical Assistance Administration (MAA) of the Department of Social and Health Services administers this program.

This interim evaluation report describes the first three years of program implementation, from July 1, 2001, to June 30, 2004. Data sources include client surveys, Medicaid claims data and eligibility history, and birth certificates from the First Steps Database.

FINDINGS

PROGRAM PARTICIPATION

• Washington's TAKE CHARGE program enrolled more than 230,000 clients in the first three years of the demonstration. While 94% (N=218,057) of the enrolled clients were female, 13,036 were male.
• The number of newly enrolled clients (Program G) (N=143,814) was nearly twice the number of clients who were automatically enrolled in the post-pregnancy extension (Program S) (N=74,242).
• Over two-thirds (68.3%) of female clients enrolled in the first three years were between the ages of 18 and 29. The same age group accounted for 73% of Medicaid-paid births in 2003.

PROVIDER ENROLLMENT
As of October 2004, TAKE CHARGE providers offered services in 194 clinics throughout the State.

PROGRAM OBJECTIVES
Four of five program objectives described in the initial application (December 1998) have been achieved, or exceeded. The fifth objective about raising provider awareness of unintended pregnancy prevention represents a long-term goal and a number of initial steps to facilitate this objective have been completed.

• An estimated 21% of the women eligible under the waiver, who would have had an unintended pregnancy, remained pregnancy free.
• The proportion of clients using a more effective family planning method increased from 53% at enrollment to 69% one year later. The proportion that reported using abstinence in the prior two months increased slightly, from 10.8% to 11.2%.
• The number of Medicaid women who received services from family planning clinics increased from 22,850 during the baseline year to 85,607 in year one, 108,253 in year two, and 121,997 in year three.
• The number of Medicaid men receiving family planning services increased from 850 during the baseline year to 3548 in year one, 4384 in year two, and 5018 in year three.

FERTILITY RATES
Fertility rates for demonstration participants are very similar to birth rates for Washington women overall, 61 - 63 births per 1000 women 15-44. The fertility rate for each of the demonstrations years is less than half the base year fertility rate (135.2 per 1000). If the births included in computation of the fertility rate are restricted to those that occurred after enrollment in TAKE CHARGE, the fertility rates are much lower (5 - 7 per 1000), comparable to the failure rate for more effective contraceptive methods.

CHARACTERISTICS OF FEMALE CLIENTS
Women with a history of a birth were older (average age 26.1 years) than clients who did not have a prior birth (average age 22.2). Overall, half the clients with a birth (51.4%) were married at the time of their most recent birth. The proportion of women married at their most
recent birth was highest for Asian women (62.2%) and women of Hispanic ethnicity (59.1%); the proportion was lowest for Native American women (28.3%). Clients who were married at their most recent birth were older (average age 24.8 years) than clients who were not married (average age 21.5 years), and the average total number of births was higher for married clients (mean 2.0) than for unmarried clients (mean 1.5).

CLIENT SERVICES
Of the total enrolled clients (N=231,093), 78% received one or more covered medical family planning service. How clients were enrolled in the program was strongly related to differences in service use. Nearly 94% of newly enrolled female clients received one or more medical family planning service, compared to 46.8% of recently pregnant women who were automatically enrolled. Among program participants, however, the proportions who used oral contraceptives and hormone injections were similar, and recently pregnant women had higher rates of use for the transdermal patch and IUDs.

CLIENT SELF-EFFICACY
Client survey questions about contraceptive self-efficacy consistently indicated modest increases in this measure one year after program enrollment; questions in other self-efficacy domains showed non-significant changes, or changes that reflected reduced self-efficacy, or perhaps more realistic expectations on the part of the clients. It had been hoped that client centered practice would result in overall improvements in client self-efficacy; however, only contraceptive self-efficacy showed consistent modest increases.

CONCLUSION: The TAKE CHARGE program has demonstrated a very great impact on access to and provision of family planning services in Washington State. Concepts of client-centered Education, Counseling, and Risk Reduction are beginning to diffuse throughout the state and establish a new standard of care for family planning practice. Demographic profiles of female clients suggest that the program is helping younger, unmarried women avoid unintended pregnancy until they are older and hopefully married. Early results indicate a greater increase in the proportion of female clients who use more effective family planning methods at sites with Intensive Follow-up Services compared to control sites. Women with automatic extension of eligibility for family planning services in the post-pregnancy period were modest users of family planning services. How TAKE CHARGE can be more effective in reaching this group remains to be explored.
 

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Modified: Wednesday February 01 2006

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