When University of Oregon student Cassidy Gibson was diagnosed with polycystic ovary syndrome her senior year of high school, her diagnosis came with a whirlwind of doctors appointments and new medications — and she quickly became familiar with how complicated health insurance and contraceptive care can be.
Gibson and her doctors were unsure of the best birth control for her, switching between five brands of the pill within 18 months of her diagnosis. Her PCOS symptoms are controlled by increasing estrogen, which most versions of the pill offer. Her insurance didn’t cover changes that came within a single month and charged her a deductible for every consultation.
Gibson said that when she came to UO in the fall of 2017, her stress was alleviated at the insurance orientation she attended her first week. The Oregon ContraceptiveCare Program, she learned, would pay for all her birth control and related appointments.
Gibson is one of 1,033 students currently enrolled in CCare at UO, according to a health center report.
CCare provides free contraceptive care to people at or below 250 percent of the federal poverty level, giving eligible UO students more flexibility in birth control options and the freedom to choose the care that works for them.
CCare is almost 20 years old and is funded through Medicaid, the federal program that helps people with low income pay for health care insurance. Staff at the Oregon Health Authority’s Reproductive Health Program noticed a gap between people who qualified for Medicaid and people who couldn’t afford private insurance. This demographic of the population was left without health coverage and was ultimately at a higher risk of unplanned pregnancies, so CCare was devised to fill this gap.
“One of the hallmarks of CCare is that individuals can apply for CCare at the clinic site on the day of their appointment, get same-day services and walk away with birth control methods,” said Emily Elman, a senior policy analyst for the Oregon Reproductive Health Program. For Oregon Health Plan, “the application process is a bit more cumbersome.”
At UO, this means students can receive birth control, condoms and Plan B immediately upon applying for the program. Registration is about a three-minute process and doesn’t require much from the student: a driver’s license or passport and insurance card if they have one.
Oregonians are eligible for the Oregon Health Program, Oregon’s state Medicaid waiver, if they make at or below 138 percent of the federal poverty level (or $16,753 annually), whereas they can be eligible for CCare if they earn $33,350 or below. Access to CCare drastically increased the number of people eligible for contraceptive care coverage in the state of Oregon.
The Oregon Health Authority estimates that 270,990 women are in need of publicly funded family planning services in the state. This is defined as the number of women who could become pregnant in Oregon between the ages of 13 and 44, with an income at or below 250 percent of the federal poverty level. CCare covers 19.3 percent of those women statewide.
In 2017, CCare prevented 1,174 unplanned pregnancies, according to the Oregon Health Authority.
While only 23.4 percent of clients statewide have private insurance coverage, 88.6 percent of UO student clients do.
For these students, CCare can be used as a “backup” option, said health center representative Julia Dunbar. When a student receives birth control through the health center, the pharmacy bills their private insurance first. And if their private insurance only covers a portion of the total amount, CCare will cover the rest.
But CCare strictly covers contraceptive care. It does not cover other forms of sexual or reproductive health care for its clients.
Other options exist for students in Eugene who are in need of more health coverage. The Planned Parenthood in Springfield is a Title X clinic. This means it is federally funded and offers complete reproductive health care, including Pap smears, STD testing and contraceptive care.
For Eugene residents, this is an option for those who are uninsured or have limited private insurance. For UO students, this can be difficult if they do not have access to a car, as the Planned Parenthood in Springfield is almost two miles from campus. But the EMX, which is free to UO students, stops in front of the building.
All university clinics in Oregon have chosen to be CCare-only, according to Elman, the state health care analyst. The process and requirements associated with becoming a full Reproductive Health Program clinic that receives Title X funds are more robust than that of CCare. She supposes that universities do not go through the trouble because the majority of students have access to CCare, OHP or private health insurance.
CCare also provides confidentiality for patients if they wish. Some students are unable to have productive conversations about contraception with parents. This could limit their options and availability of birth control.
When helping students apply for CCare, Dunbar said she always checks if they would like to keep their information private or not. This gives students the freedom to decide which care is best for them. Dunbar estimates that 20 percent of students ask that their information remain confidential.
One UO senior applied for CCare her freshman year because she needed birth control but did not feel comfortable discussing those options with her parents, even though their insurance covered contraceptives. CCare provided the privacy and health care she wanted. She wished to remain anonymous in this article for the same reason she applied to CCare.
In the past, she has needed enough birth control to last through long breaks away from school when returns home to California. CCare coverage allows for extended prescriptions up to 15 months and maintains students’ privacy while living at home.
If a student visited a Planned Parenthood at any point and registered for CCare in the past year, they are automatically enrolled in the program. “A lot of students do not even realize that they are on it,” Dunbar said.
The pharmacy desk at the health center has paperwork to offer CCare as an option when students come to pick up their prescription. Dunbar hopes that this will combat the problem in the future.
CCare clients at UO have decreased over the last two years by 500 patients. Dunbar believes this is due to the lack of marketing resources for the program and a change in insurance laws where dependents can be covered up to age 26.
“I get really frustrated when I see the pharmacy bill insurance and the insurance only covers three months, and the person is graduating and has to pay like $300 out of pocket,” Dunbar said. “I always wonder: Why didn’t we tell them about CCare?”
The program only covers about 2.5 percent of students at UO, but Dunbar said they are working on ways to expand coverage. Dunbar said only two of those students are men, even though the program is offered to all genders.
Dunbar said she has spoken to a campus group about promoting the program to men because they offer options such as condoms and consultation appointments.
As of 2016, the state of Oregon also requires insurance to cover up to a year’s worth of birth control with established patients at one time. Dispensing a year’s supply of birth control reduces the odds of unplanned pregnancy by 30 percent, compared to dispensing smaller amounts more frequently, according to Planned Parenthood.
Colleen Jones, a nurse practitioner with the UO Health Center, inserts five to 10 intrauterine devices every week and consults most of her patients on all forms of birth control. She thinks the most valuable aspect of CCare is its ability to cover all types of contraception.
“That’s the most important thing with health care,” she said. “When you’re working with human beings, you cannot treat everyone the same.”
Jones said that UO students are really lucky to have the program. She avoids recommending specific forms of contraception to students, instead giving them all the information, answering questions and encouraging them to make the final decision based on their own needs.
While the pill requires more attention from the user, the IUD can be painful. CCare allows students to consider all those options without worrying about cost.
Gibson, the student who was diagnosed with polycystic ovary syndrome, experimented with how several of these different birth controls affected her PCOS and could do so with the financial support of CCare. She said that in the year that she has used the program, she has enjoyed sharing her experiences with her friends and encouraged them to consider applying.
“It’s not even about contraceptive for me right now,” Gibson said. The pill is the only way to curb the painful symptoms that come with PCOS. “I’m jealous of people that can stick with one form [of birth control]. In that case, traditional insurance works for them. CCare is what works for me.”