Date of Publication:

June 30, 2017

To identify the barriers, strategies, and infrastructure required for Title X centers to contract with health insurers, as well as successful systems whereby Title X providers can provide confidential services while billing insurance for the visit, the Altarum Institute, in partnership with the Urban Institute, conducted a qualitative case study inquiry of current practices of providers, states, and health plans that may inform future practice and policy. This study is unique in that it investigates and presents the perspectives of multiple stakeholders, including Title X grantees, health plans, Medicaid officials, and health center clients (adolescents and adult women) from a diverse set of states.

This report presents the results of this study and the implications for state health insurance law and regulations, the health insurance system, and the contracting and billing practices of Title X-funded health centers. Chapter 2 provides an overview of our research approach, including state selection and key informant and focus group recruitment methods.

Chapter 3 presents the main research findings, which include information about changes in Title X service demand and demographics, shifts resulting directly from implementation of the ACA, implications for both Medicaid and third-party insurance billing, and the protection of confidential health information. Finally, Chapter 4 details practices in the field identified in this study. These include practices undertaken by Title X grantees, state legislatures, health insurers, and the Title X-funded health centers themselves. The practices identified here have the potential to help health centers preserve client confidentiality while responding to changes in the health insurance market.