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Contraceptive Coverage and Access

Why is Contraceptive Access Important?

Everyone deserves the power to decide if, when, and under what circumstances to get pregnant and have a child. Contraception, which is available in a wide array of methods, is key for people who don’t want to get pregnant. Unfortunately, there are many barriers to accessing contraception. 
 
For example, more than 19 million women eligible for publicly funded contraception live in what we call a contraceptive desert, meaning they live in a county lacking reasonable access to the full range of contraceptive methods. These barriers put people already struggling to make ends meet at risk of not being able to get the birth control method right for them. 

Even when access to birth control exists, cost can be a barrier. Programs that serve those without health insurance, like the Title X Family Planning Program, public insurance programs like Medicaid, and policies that ensure no co-pay coverage of contraception–like the Affordable Care Act’s Women’s Preventive Services provision help to make affordable birth control a reality for more people.
All of these policies and programs currently face threats. It’s important that we protect and expand coverage and access to contraception for every person.

Title X Family Planning

About the Title X Family Planning Program

For more than 50 years, the Title X family planning program has played a critical role in preventing unplanned pregnancy by offering high-quality contraceptive services, preventive screenings, and health education to low-income women and men. In addition to Medicaid, Title X is an important part of the health care safety net.

Funding Status

Funded at $286.5 million for FY 2025 (through September 30, 2025).

Now that policymakers have begun the 119th Congress, we urge Members of Congress to work to protect and support programs that work towards reproductive well-being. Contact your representatives and urge them to protect and support the Title X Family Planning Program in FY26.

Most recent Action: 

  • At the end of April, the Trump administration released its “skinny” budget for FY 2026, proposing to eliminate the Title X Family Planning Program. As Congress takes the President's proposal into consideration, stay tuned for additional updates

What happened previously:

  • On March 30, 2025, HHS withheld $65.8 million in Title X funding from grantees, leaving 8 states without any Title X funded health centers and many more with significantly reduced funding, and impacting 30% of Title X patients.
  • On April 14, 2025, our partners at the National Family Planning and Reproductive Health Association (NFPRHA), the American Civil Liberties Union (ACLU), and ACLU District of Columbia announced that it would sue the Trump administration over its unlawful withholding of Title X funds. As litigation continues, stay tuned for additional updates.

What Can You Do to Support Title X?

Sign this petition to tell RFK Jr. and HHS to stop their attacks on the Title X Family Planning Program. You and your community deserve better.  
And now that policymakers have begun the 119th Congress, we urge Members of Congress to work to protect and support programs that work towards reproductive well-being. Contact your representatives and urge them to protect and support the Title X Family Planning Program in FY 2026.

Resources

Medicaid

About Medicaid 

The Medicaid program is a partnership between states and the federal government, with several different pathways to eligibility. States have been required to cover family planning services for reproductive age beneficiaries since 1972. States also have the option to provide a more limited set of benefits, such as family planning services, to those with income above the traditional Medicaid eligibility levels. Twenty-six states have federal Medicaid Family Planning expansions. In addition, 40 states (including Washington, DC) have implemented the full Medicaid expansion in order to provide health insurance coverage to low-income, non-disabled adults (a group that was not eligible under traditional Medicaid), as the ACA allows. Medicaid plays a vital role in offering contraception to low-income individuals, accounting for 75% of public spending on family planning.

Current Status

 As Congress moves through their reconciliation process, the current legislation includes huge cuts to Medicaid coverage and access that will significantly reduce access to contraceptive care as well as overall health care access.

How Can You Help Protect Medicaid?


As reconciliation legislation now moves to the Senate, it’s vital that Senators hear how bad this bill will be for the reproductive health of people who depend on Medicaid. Contact your Senators and tell them to oppose H.R. 1 and protect Medicaid coverage of reproductive health care.

Resources

No Co-Pay Birth Control

About No Co-Pay Birth Control

Thanks to the Women’s Preventive Services provision of the ACA, women covered by Medicaid expansion, marketplace, and employer-based plans are not required to pay extra out-of-pocket costs for women’s preventive services, which includes birth control. An estimated 62.1 million women benefit from the Women’s Preventive Services provision. Women also saved at least $1.4 billion in out-of-pocket costs for birth control pills in a single year, and there is evidence that the provision is increasing the ability of women to obtain more effective birth control methods for those who want it.


In 2024, Congress passed and President Biden signed into law the Fiscal Year 2025 National Defense Authorization Act (NDAA) which included a provision expanding no co-pay contraceptive coverage to all military servicemembers and dependents covered by TRICARE, the military health insurance program. Previously, only active-duty servicemembers had no co-pay coverage. The new law means roughly 1.4 million women of reproductive age on TRICARE now have no co-pay coverage of the full range of contraceptive methods.


Current Status: 


In May 2022, Power to Decide released a new report When Your Birth Control Isn't Covered that reveals troubling new evidence of health insurance companies failing to provide coverage of the full range of birth control options with no out-of-pocket expense, as required under the Affordable Care Act (ACA).


Consumers continue to experience issues with no co-pay coverage, but overall the benefit continues to be significant. 


Finally, we know that over-the-counter methods like Opill, some forms of emergency contraception and internal condoms are not always covered by insurance unless you have a prescription. This is already a problem for people using those methods, and it could become an even bigger problem in the future if some birth control pills become available over the counter.
 

Resources

  • Power to Decide: When Your Birth Control Isn't Covered - This report reveals troubling evidence of health insurance companies failing to provide coverage of the full range of birth control options with no out-of-pocket expense, as required under the Affordable Care Act (ACA).
Over the Counter Birth Control

Latest Action on Over-the-Counter (OTC) Birth Control

On March 25, 2024, the pharmaceutical company, Perrigo released the Opill Cost Assistance Program (Opill CAP) for the first FDA-approved over-the-counter (OTC) birth control pill, Opill. Uninsured individuals living at or below 200% of the federal poverty level (or $30,120 annually for an individual) will be eligible for Opill at reduced or no cost. You can read Power to Decide's statement on Opill CAP here. 

Background

  • On March 4, 2024, Perrigo announced that it would begin shipping the first ever FDA-approved OTC daily oral contraceptive pill, Opill, to retailers across the country. This marks a historic advancement in access to contraception, which for decades advocates have been fighting for. For more information, please see Power to Decide's statement on Perrigo's announcement.
  • In July 2023, the U.S. Food and Drug Administration (FDA) approved the progestin-only birth control pill, Opill, for OTC access without an age restriction, in accordance with their Advisory Committee’s unanimous vote in favor of approval.
  • In July 2022, HRA Pharma submitted the first-ever application to the FDA to make a progestin-only form of daily birth control available over the counter.

About Over the Counter Birth Control

Research has shown that OTC contraceptive pills are a safe and effective method of birth control. OTC birth control pills don't remove the need to see a doctor regularly for things such as well woman visits, Pap smears, and IUD placement. However, removing the barrier of a prescription can increase access not just for the 19 million women in deserts, but for everyone across the country.

Physician groups, including the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians and the American Medical Association have supported efforts to move the pill over the counter.

Resources