Any patient, any method, any day... any language

During Upstream’s initiative in Delaware, we launched a program we referred to internally as “All Methods Free.” Funded by Upstream, it provided access to any birth control method for free for any patient who visited participating health centers in Delaware and this included nearly every major health center in the state. From 2017 through early 2019, more than 5,300 patient visits were covered through All Methods Free, not including those who received free contraception via their health insurance.

Three aspects of All Methods Free which have received some attention are the fact that it covered all methods of birth control (including free removals), provided transportation reimbursements and eliminated all cost sharing and co-pays – innovations that are necessary, though not sufficient, to have truly equitable access to family planning services.

Another aspect of Upstream’s All Methods Free program that often gets overlooked is that we provided access to patients who could not afford to pay up front costs and wait for reimbursement. In most cases, Upstream was able to reimburse health centers directly so that health centers could make contraception free. While similar programs that reimburse patients rather than health centers are a positive step, we were able to go one step further by eliminating the barrier of any up front out-of-pocket costs. This had two other important benefits. First, it made it easier for us to not ask for any proof of income. Some patients, particularly undocumented individuals, may not seek even free services if proof of income is required. They may lack proof of income documents or may fear that providing pay stubs or other documentation may reveal to authorities that they are undocumented. Second, reimbursing health centers directly meant that because there were no online forms to complete for reimbursement, we eliminated a common language barrier that patients may encounter. Thus we were able to facilitate easier access to patients who speak any language that our partner health centers provide care for.

We did create a backup online reimbursement mechanism to use when a health center was unable or unwilling to provide free access. However, enabling most patients to simply receive free services with no reimbursement paperwork eliminated burdensome documentation that often creates a language barrier.

Our goal was to provide any patient access to any method on any day for free. By reimbursing health centers directly, we were also able to support access in any language supported by the health centers we partner with. These partnerships also included training and materials grounded in cultural humility. Through new increased investments in the Title X network the state of Delaware has also taken an important step in ensuring that this expanded access continues.

Running a program to make birth control free for all patients is not easy. However, there are now several examples across the country of programs that have provided free contraception and had significant benefits. What we learned is that when we provide free contraception by setting it up directly through our partner health centers, we can get closer to our goal of free access for all.