New research with community college students in Texas and California offers compelling evidence that state policies and programs impact young people’s ability to use the birth control method of their choice.

Young people being able to use the method of birth control they want is an indicator of their health care access and reproductive autonomy. State policies that increase insurance coverage for birth control and reduce cost and other barriers may help facilitate young people’s access to birth control.

California is one of 38 states that have expanded full-benefit Medicaid coverage, and young adults can enroll up to age 26 regardless of their immigration status. The state also has the Family PACT Program, which provides family planning services at no cost to California residents of childbearing age for people making up to 200% of the federal poverty level.

Texas has not expanded Medicaid, and only extends coverage to US citizens and authorized immigrants who care for dependent children and have incomes up to 16% of the federal poverty level. Texas has also implemented a series of restrictive state policies that excluded certain providers from participating in family planning programs, which led many family planning clinic to close.

Researchers from Beyond the Pill and the University of Texas explored the impact of insurance coverage on use of preferred birth control method in Texas and California.

Around 1/3 of Texas students and just over 1/2 of California students were predicted to be using their preferred method.
Young people in Texas reported financial barriers more frequently and were less likely to be using their preferred method than young people in California.
Fewer uninsured Texans were using their preferred method compared to insured Texans.
Regardless of where they lived or whether they had insurance, about 1/2 of the students said they weren’t using their preferred method because of information or availability barriers. More than 1/3 said they weren’t using their preferred method because they didn’t want their parents to know that they were sexually active.

This research presents new evidence that state of residence plays an important role in young people’s ability to use their preferred birth control method, magnified by differences in insurance coverage. Researchers didn’t find a difference in using the preferred method between uninsured and insured Californians, suggesting that California’s strong family planning safety net is helping to provide widespread coverage to many uninsured residents. The more restrictive health care policy environment in Texas, including budget cuts to publicly funded services and restrictions on who can provide those services, all likely play a role in Texas students’ limited use of their preferred method.

It's critical to expand access to preferred birth control methods in all states, and it has become especially urgent to support young people’s access in states with abortion bans.