Iowa Family Planning Demonstration Evaluation Second Waiver Period

The State of Iowa is expanding an 1115 Family Planning Demonstration which will continue the work began in February 2006 through December, 2013. The waiver provides family planning service to men and women 12-54 years of age with income not exceeding 300% of the Federal poverty level for the family size. The extension contains theses objectives:
1. Improve the access to and use of Medicaid family planning services by women who have received a Medicaid pregnancy related service.
2. Improve birth outcomes and the health of women by increasing the child spacing interval among women in the target population.
3. Decrease the number of Medicaid paid deliveries, which will reduce annual expenditures for prenatal, delivery newborn, and infant care.
4. Reduce the number of unintended and unwanted pregnancies among women eligible for Medicaid.
5. Reduce teen pregnancy by reducing the number of repeat teen births.
6. Estimate the overall savings in Medicaid spending attributable to providing family planning services to women for 2 years postpartum.

The final report for the evaluation of the first 5 years of the waiver program indicated the following successes and opportunities.

Successes
1. The demonstration has increased the numbers of women receiving family planning services within the Medicaid program. Over 65,000 women have accessed family planning services through this demonstration.
2. The repeat birth rates for women accessing family planning services have dropped for most age groups with large decreases among teens.
3. Reductions in Medicaid costs for deliveries and birth and first year of life are over $50 million.
4. Net Medicaid savings are well over $10 million from this demonstration.

Evaluation
The evaluation plan for the extension will mirror the previous work very closely with adjustments for changes in the objectives as reflected above. In particular, we will include men in the analyses of family planning service usage and return to the idea of children that were not born as unintended rather than averted. The evaluation budget is limited to $20,000 per year. This level of resource support provides no funding for survey work or extensive data analyses. For this reason, the evaluation team is unable to perform target surveys to determine whether births were intended or unintended as has been done by other evaluation teams. Complex modeling to determine the effects of the expansion are also limited due to time and resource constraints. The simple evaluation plan provided may not adequately address all of the state’s objectives.