Federal Policy and Access to Contraception
Written by Silpa Srinivasulu, MPH
Since it took effect in 2012, the Affordable Care Act (ACA) has mandated that public and most private health insurance plans cover the full range of contraceptive methods (at least one form in each of the 18 method categories) and related services and counseling for people with reproductive capacity without patient cost-sharing. In 2019 (and reaffirmed in 2022), HRSA expanded the guarantee to include all FDA-approved “female-controlled” methods, including sterilization, emergency contraception, and long-acting reversible contraceptives (LARC).1 Some insurance plans are exempt, like “grandfathered plans” (existed before the ACA and have not been changed substantially to cut benefits or increase costs) and “church plans” (established by religious organizations, and employers or universities that religiously or morally object to covering contraception for employees and students).2,3
Extensive research has demonstrated that the federal contraceptive coverage guarantee has significantly decreased patients’ out-of-pocket spending and improved their abilities to exercise reproductive autonomy by using their preferred birth control method.4,5 For example, 69% of OBGYNs reported an increase in patients using their desired contraceptive method since the ACA took effect.6 Multiple studies indicate that it has increased the use of prescription methods, particularly IUDs and implants, and consistent contraceptive use.7 A retrospective cohort study of members within a large healthcare system found the contraceptive coverage mandate led to increased contraceptive use and reduced pregnancy rates.8
Despite the ACA’s advancement in contraceptive access and affordability, coverage barriers remain and may worsen under the Trump administration.9,10,11 In spring 2025, HHS withheld $65.8 million in Title X federal family planning grants in 20 states based on grantees’ public statements opposing racism and supporting diversity, equity, and inclusion.12 HR 1, passed in July 2025, blocks Medicaid funding for one year to nonprofits defined as essential community providers primarily engaged in family planning, offered abortion care beyond Hyde exceptions, and received over $800,000 in Medicaid reimbursement in FY23, affecting all Planned Parenthood clinics and other large family planning clinics.13
While efforts to undermine contraceptive access and affordability persist, models exist across states to preserve or expand access, largely informed by the National Health Law Program’s Model Contraceptive Equity Act.14 Twelve states expanded access by requiring coverage without cost-sharing of all FDA-approved contraceptives (not just one per method category), 28 states and DC allow pharmacists to prescribe contraceptives, and ten states require certain state-regulated plans to cover some OTC contraception. Several states, like Illinois, New York, and Washington, have family planning benefit programs to expand insurance coverage of contraception when gaps in other public or private insurance leads to affordability barriers. As demand for contraception increases in an environment where reproductive health care grows increasingly restricted, states can advance access by:15
- Supporting community health centers and other primary care practices to offer the full range of contraception through comprehensive training, technical assistance, and funding.
- Leveraging insurance mechanisms by enacting family planning benefit programs; allowing pharmacists to prescribe contraceptives; covering OTC contraception without prescription, 12-month supplies of birth control prescriptions, and vasectomy; and requiring coverage without cost-sharing of all FDA-approved contraceptive products.
RHAP Resources:
Your Birth Control Choices Fact Sheet
Medical Eligibility Criteria for Initiating Contraception
Download and print our resources for free from our website or visit our store to buy physical copies!
Partner Resources:
Reproductive Health Hotline (ReproHH)
A free, confidential phone service (1-844-737-7644) offering evidence-based clinical information for healthcare providers across the US who have questions related to sexual and reproductive health.
Breast Cancer and Contraception: Counseling and Supporting Patient Decision Making: The goal of this activity is that learners will have greater knowledge and confidence regarding onco-contraception, which refers to contraceptive education, counseling, and care in the context of a person’s cancer diagnosis, treatment, and personal goals of care.
Sources:
*To date HHS has archived this content
1. Affairs (ASPA) AS for P. Secretaries Becerra, Walsh and Yellen Underscore Contraceptive Coverage Requirements for Private Insurance. www.hhs.gov. Published June 27, 2022. https://www.hhs.gov/about/news
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