Family Planning Confidential: A Qualitative Research Study on the Implications of the Affordable Care Act
A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients’ ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousa...
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Published in | Journal of adolescent health Vol. 63; no. 6; pp. 773 - 778 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.12.2018
Elsevier BV |
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Abstract | A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients’ ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousands of individuals. But, billing third-party payers for family planning services can result in the generation of explanations of benefits and other communications to the policy holder that may compromise confidentiality for covered dependents.
The research team facilitated 12 focus groups with 62 Title X clients in 5 states and conducted interviews with 91 health center key informants in 10 states. Transcripts were coded using NVivo version 10.0. Researchers used deductive coding and grounded theory to search for themes.
Clients expressed confusion about the difference between confidential services from their health center versus confidential communications from their health insurance plan. Health center staff also highlighted confidentiality issues that may arise from ACA insurance expansion and revealed that clients overall do not understand how health insurance works, particularly younger clients and those that were newly covered under the ACA.
Many Title X supported health centers will continue not to bill insurance if there are concerns regarding confidentiality, especially with their adolescent and young adult clients. Despite additional revenue sources that have emerged since the passage of the ACA, Title X funding may remain critical for clients who need safe, affordable, and confidential care. |
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AbstractList | Purpose: A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients’ ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousands of individuals. But, billing third-party payers for family planning services can result in the generation of explanations of benefits and other communications to the policy holder that may compromise confidentiality for covered dependents. Methods: The research team facilitated 12 focus groups with 62 Title X clients in 5 states and conducted interviews with 91 health center key informants in 10 states. Transcripts were coded using NVivo version 10.0. Researchers used deductive coding and grounded theory to search for themes. Results: Clients expressed confusion about the difference between confidential services from their health center versus confidential communications from their health insurance plan. Health center staff also highlighted confidentiality issues that may arise from ACA insurance expansion and revealed that clients overall do not understand how health insurance works, particularly younger clients and those that were newly covered under the ACA. Conclusions: Many Title X supported health centers will continue not to bill insurance if there are concerns regarding confidentiality, especially with their adolescent and young adult clients. Despite additional revenue sources that have emerged since the passage of the ACA, Title X funding may remain critical for clients who need safe, affordable, and confidential care. A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients' ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousands of individuals. But, billing third-party payers for family planning services can result in the generation of explanations of benefits and other communications to the policy holder that may compromise confidentiality for covered dependents. The research team facilitated 12 focus groups with 62 Title X clients in 5 states and conducted interviews with 91 health center key informants in 10 states. Transcripts were coded using NVivo version 10.0. Researchers used deductive coding and grounded theory to search for themes. Clients expressed confusion about the difference between confidential services from their health center versus confidential communications from their health insurance plan. Health center staff also highlighted confidentiality issues that may arise from ACA insurance expansion and revealed that clients overall do not understand how health insurance works, particularly younger clients and those that were newly covered under the ACA. Many Title X supported health centers will continue not to bill insurance if there are concerns regarding confidentiality, especially with their adolescent and young adult clients. Despite additional revenue sources that have emerged since the passage of the ACA, Title X funding may remain critical for clients who need safe, affordable, and confidential care. PURPOSEA cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients' ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousands of individuals. But, billing third-party payers for family planning services can result in the generation of explanations of benefits and other communications to the policy holder that may compromise confidentiality for covered dependents. METHODSThe research team facilitated 12 focus groups with 62 Title X clients in 5 states and conducted interviews with 91 health center key informants in 10 states. Transcripts were coded using NVivo version 10.0. Researchers used deductive coding and grounded theory to search for themes. RESULTSClients expressed confusion about the difference between confidential services from their health center versus confidential communications from their health insurance plan. Health center staff also highlighted confidentiality issues that may arise from ACA insurance expansion and revealed that clients overall do not understand how health insurance works, particularly younger clients and those that were newly covered under the ACA. CONCLUSIONSMany Title X supported health centers will continue not to bill insurance if there are concerns regarding confidentiality, especially with their adolescent and young adult clients. Despite additional revenue sources that have emerged since the passage of the ACA, Title X funding may remain critical for clients who need safe, affordable, and confidential care. |
Author | Briceno, Ana Carolina Loyola Rogers, Jennifer Silva, Sandra Benatar, Sarah |
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Keywords | Family planning Young adults Confidentiality Billing Adolescents Medicaid Title X ACA |
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References_xml | – ident: bib0001 article-title: Family Planning Annual Report: 2015 National Summary contributor: fullname: Lasater – ident: bib0003 – ident: bib0004 – volume: 50 start-page: 51 year: 2018 end-page: 57 ident: bib0014 article-title: Title X-funded health center staff members’ perspectives on barriers to insurance use for confidential family planning services publication-title: Persp Reprod Sexual Health contributor: fullname: Wood – volume: 25 start-page: 91 year: 2015 end-page: 96 ident: bib0011 article-title: Barriers to contraceptive access after health care reform: Experiences of young adults in Massachusetts publication-title: Women's Health Issues contributor: fullname: Havard – volume: 31 start-page: 1039 year: 2012 end-page: 1048 ident: bib0006 article-title: Implications for reform: Survey of California adults suggests low health literacy predicts likelihood of being uninsured publication-title: Health Affairs contributor: fullname: Sentell – volume: 40 start-page: 383 year: 2012 end-page: 390 ident: bib0009 article-title: Health reform and the preservation of confidential health care for young adults publication-title: J Law Med Ethics contributor: fullname: Cramer – volume: 18 start-page: 279 year: 2016 end-page: 287 ident: bib0007 article-title: Privacy protection in billing and health insurance communications publication-title: AMA J Ethics contributor: fullname: Lewis – volume: 88 start-page: 684 year: 2013 end-page: 690 ident: bib0015 article-title: Translating access into utilization: Lessons from the design and evaluation of a health insurance Web site to promote reproductive health care for young women in Massachusetts publication-title: Contraception contributor: fullname: Foster – volume: 35 start-page: 160 year: 2004 end-page: 167 ident: bib0002 article-title: SAM confidential health care for adolescents: Position paper for the Society for Adolescent Medicine publication-title: J Adolesc Health contributor: fullname: Sigman – volume: 49 start-page: S85 year: 2015 end-page: S92 ident: bib0012 article-title: Confidentiality in family planning services for young people: A systematic review publication-title: Am J Prev Med contributor: fullname: Weik – volume: 16 start-page: 2 year: 2013 end-page: 7 ident: bib0008 article-title: A new frontier in the era of health reform: protecting confidentiality for individuals insured as dependents publication-title: Guttmacher Policy Rev contributor: fullname: Gold – volume: 11 start-page: 50 year: 2014 ident: bib0013 article-title: Do we still need Title X? Perceptions of and preferences for federally-funded family planning clinics publication-title: Reprod Health contributor: fullname: Oglesby – volume: 31 start-page: 434 year: 2012 end-page: 443 ident: bib0016 article-title: New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care' publication-title: Health Affairs contributor: fullname: Clancy – volume: 306 start-page: 874 year: 2011 end-page: 875 ident: bib0005 article-title: Insurance expansion and health literacy publication-title: JAMA contributor: fullname: Parker – volume: 22 start-page: e519 year: 2012 end-page: e525 ident: bib0010 article-title: Specialized family planning clinics in the United States: Why women choose them and their role in meeting women's health care needs publication-title: Women's Health Issues contributor: fullname: Bucek – volume: 88 start-page: 684 issue: 6 year: 2013 ident: 10.1016/j.jadohealth.2018.06.020_bib0015 article-title: Translating access into utilization: Lessons from the design and evaluation of a health insurance Web site to promote reproductive health care for young women in Massachusetts publication-title: Contraception doi: 10.1016/j.contraception.2013.09.004 contributor: fullname: Janiak – volume: 22 start-page: e519 year: 2012 ident: 10.1016/j.jadohealth.2018.06.020_bib0010 article-title: Specialized family planning clinics in the United States: Why women choose them and their role in meeting women's health care needs publication-title: Women's Health Issues doi: 10.1016/j.whi.2012.09.002 contributor: fullname: Frost – volume: 31 start-page: 434 year: 2012 ident: 10.1016/j.jadohealth.2018.06.020_bib0016 article-title: New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care' publication-title: Health Affairs doi: 10.1377/hlthaff.2011.1169 contributor: fullname: Koh – volume: 31 start-page: 1039 issue: 5 year: 2012 ident: 10.1016/j.jadohealth.2018.06.020_bib0006 article-title: Implications for reform: Survey of California adults suggests low health literacy predicts likelihood of being uninsured publication-title: Health Affairs doi: 10.1377/hlthaff.2011.0954 contributor: fullname: Sentell – volume: 40 start-page: 383 year: 2012 ident: 10.1016/j.jadohealth.2018.06.020_bib0009 article-title: Health reform and the preservation of confidential health care for young adults publication-title: J Law Med Ethics doi: 10.1111/j.1748-720X.2012.00671.x contributor: fullname: Slive – volume: 25 start-page: 91 year: 2015 ident: 10.1016/j.jadohealth.2018.06.020_bib0011 article-title: Barriers to contraceptive access after health care reform: Experiences of young adults in Massachusetts publication-title: Women's Health Issues doi: 10.1016/j.whi.2014.11.002 contributor: fullname: Bessett – ident: 10.1016/j.jadohealth.2018.06.020_bib0001 contributor: fullname: Fowler – volume: 18 start-page: 279 issue: 3 year: 2016 ident: 10.1016/j.jadohealth.2018.06.020_bib0007 article-title: Privacy protection in billing and health insurance communications publication-title: AMA J Ethics doi: 10.1001/journalofethics.2016.18.3.pfor4-1603 contributor: fullname: English – ident: 10.1016/j.jadohealth.2018.06.020_bib0017 – volume: 50 start-page: 51 year: 2018 ident: 10.1016/j.jadohealth.2018.06.020_bib0014 article-title: Title X-funded health center staff members’ perspectives on barriers to insurance use for confidential family planning services publication-title: Persp Reprod Sexual Health doi: 10.1363/psrh.12054 contributor: fullname: Masselink – volume: 49 start-page: S85 year: 2015 ident: 10.1016/j.jadohealth.2018.06.020_bib0012 article-title: Confidentiality in family planning services for young people: A systematic review publication-title: Am J Prev Med doi: 10.1016/j.amepre.2015.04.001 contributor: fullname: Brittain – volume: 11 start-page: 50 year: 2014 ident: 10.1016/j.jadohealth.2018.06.020_bib0013 article-title: Do we still need Title X? 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Snippet | A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients’ ability to pay. This is particularly... A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients' ability to pay. This is particularly... Purpose: A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients’ ability to pay. This is... PURPOSEA cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients' ability to pay. This is... |
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SubjectTerms | Ability to pay ACA Adolescents Billing Charges Clients Communication Confidentiality Confusion Dependents Family planning Family planning services Grounded theory Health education Health facilities Health information Health insurance Interpersonal communication Medicaid Patient Protection & Affordable Care Act 2010-US Patients Qualitative research Respondents Teams Teenagers Title X Young adults |
Title | Family Planning Confidential: A Qualitative Research Study on the Implications of the Affordable Care Act |
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