All ETDs from UAB

Advisory Committee Chair

Martha Wingate

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Background: Much research has been done investigating health disparities in the field of publicly-funding family planning. However, no longitudinal analysis has been conducted to examine the impact of Alabama Medicaid’s Section 1115 demonstration waiver on access to care, experience of barriers reported by enrollees, and repeat utilization of services. Methods: Medicaid enrollment and visit claims data were used to answer the questions related to access and service utilization. Annual Plan First survey data were used to investigate the experience of barriers to care among enrollees. For all three research questions, descriptive statistics were calculated, and linear probability models were used to determine the association between demographic data and other related variables and the outcomes of interest. Results: We found that race/ethnicity, age, year of enrollment, and geography of residence were significant predictors of whether a woman accessed care within their first twelve months of enrollment. Each of these descriptors, as well as whether a woman had a LARC visit in their first year of enrollment, were also significant predictors of whether a woman returned for care in a timely manner. Race/ethnicity, education level, relationship status, year of survey administration, and PHA were found to be significant predictors of a woman’s experience with availability, accommodation, and affordability barriers. Across all three research questions, several findings went against trends observed in the published literature, such as non-Hispanic Black women and women from rural counties having increased likelihood to access/return for care. The changing trends in uptake of and the experience of barriers to care over time also highlight potential external factors that may have influenced women’s healthcare seeking behaviors. Conclusions: Disparities persist across every stage of the healthcare continuum, from accessing care to returning for follow-up services. This research has shown the importance of routine monitoring and evaluation, but also the need for further rigorous analysis of the Plan First program.

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