Impact of Medicare and Medicaid coverage policies on contraceptive use among people with disabilities

PROJECT SUMMARY
In the United States, women with disabilities are 32% less likely to use any contraceptive method compared to
women without disabilities and have higher rates of unintended pregnancy and adverse pregnancy outcomes.
In qualitative interviews, women with disabilities have stated that insufficient Medicare coverage of desired
contraceptive methods is a barrier to contraceptive use. Medicare is a federal health insurance program that
provides coverage to nearly 1.5 million women aged 20 to 49 years who receive Social Security Disability
Insurance due to a chronic disability. Unlike private insurance plans and Medicaid, Medicare does not cover
most contraceptive methods for pregnancy prevention. Individuals who are dual enrolled in Medicaid and
Medicare due to a combination of low-income and disability receive contraceptive coverage through Medicaid.
The goal of this proposed research is to evaluate the impact of Medicare’s contraceptive coverage policies on
contraceptive use among women with disabilities. Using 2016-2021 inpatient, outpatient, carrier, and
pharmaceutical Medicare and Medicaid claims data from all 50 states and D.C., I will examine differences in
contraceptive use between women with disabilities enrolled in traditional Medicare, Medicare Advantage,
Medicaid, and dual enrolled (Aim 1). I will then evaluate the impact of gaining contraceptive coverage through
dual enrollment on contraceptive method use among Medicare enrollees with disabilities (Aim 2). This research
will provide some of the first empirical evidence for policymakers on reproductive healthcare access and use
among Medicare enrollees with disabilities. I will complete the analyses with support from collaborators with
expertise in disability and reproductive health policy and claims data analysis, as well routine input from a
community advisory board of women with disabilities. I am supported by an interdisciplinary research
environment that includes the Center for Gerontology and Health Care Research and Center for Advancing
Health Policy through Research at the Brown University School of Public Health. The training activities detailed
in this application are focused on developing advanced methods in causal inference, best practices in
conducting person-centered research, experience communicating research for policy impact, and teaching.
These activities will prepare me for a career as an independent researcher and professor focused on improving
reproductive healthcare access and outcomes among people with disabilities.

Grant Number: 5F31HD116515-02
NIH Institute/Center: NIH
Principal Investigator: Meghan Bellerose