How low-income people can get affordable contraception after the Big, Beautiful Act

🌟 Introduction

The One Big Beautiful Bill (OBBB), signed into law on July 4, 2025, brought sweeping changes—cutting Medicaid funding and adding work or activity requirements. One major change: Medicaid cannot reimburse providers like Planned Parenthood for one year if they offer abortion services, even for non-abortion care like contraception and cancer screenings. This directly affects low-income women, teens, people of color, undocumented individuals, and rural residents. Many rely on Medicaid and Title X to cover birth control, IUDs, shots, and counseling. So how can individuals still access affordable contraception? Here's a practical guide.

Detailed OBBB Provision on Contraception

OBBB’s Medicaid clause:

• Prohibits Medicaid reimbursements for all care—not just abortion—for providers who offered abortion services and received over $800,000 in federal funding in 2023, such as Planned Parenthood affiliates .
• In one year, about 200 clinics may stop accepting Medicaid, directly impacting services like birth control, Pap smears, and STD testing.
• Title X and private insurance under ACA aren't affected by this. But low-income and Medicaid-dependent patients are left vulnerable.

How Low-Income Individuals Can Still Access Affordable Contraception

1. Keep ACA or Medicaid Expansion Coverage Thanks to the ACA, most private and Medicaid-expanded plans must fully cover FDA-approved contraceptives, including insertion/removal, with no cost-sharing
2. Visit Title X Family Planning Clinics Funded by HHS (about $287M in 2023), serving 2.8M clients (The White House). Offers sliding-fee pricing—always based on income, never outright charges.
3. Use FQHCs (Federally Qualified Health Centers) Offer care regardless of insurance status, with sliding-fee options under Medicaid or Title X. Provide confidential services that include contraception, screenings, and counseling.
4. Check Planned Parenthood in Your Area Some affiliates may still accept Medicaid/Title X depending on state enforcement. Ask directly about contraceptive service costs and coverage.

Options Summary Table

Step-by-Step Startup Guide

1. Check Your Insurance Review your ACA marketplace or Medicaid plan to confirm contraceptive coverage with no cost-sharing.
2. Find a Title X site Use Health & Human Services’ clinic finder or Planned Parenthood to locate nearby Title X family planning centers.
3. Call Planned Parenthood Ask whether Medicaid or Title X are still accepted in your state, and what out-of-pocket fees apply.
4. Visit a Local FQHC Check sliding-fee eligibility. These centers don’t check status
5. Ask What’s Included Inquire about contraceptive methods available (pills, IUD, implant, shot, ring) and include counseling or follow-up in your visit.

What Lies Ahead for Low-Income Groups

• Pressure on clinics: Reduced Medicaid funds may cause longer wait times or closures; backup options like FQHCs and Title X will be vital .
• Policy advocacy: Support for extending ACA contraception protections and defending Title X funding is ongoing. Provincial, nonprofit, and political actions are underway.
• Alternative access: Expanding over-the-counter options and telehealth prescriptions could help if formal clinic access is limited.

Q&A

Q: If my local Planned Parenthood stops Medicaid, where do I go?
A: Use Title X clinics or FQHCs—they’ll offer the same contraceptives and care based on income.

Q: What if I don’t have any insurance?
A: Title X and FQHCs are designed to serve uninsured individuals on sliding fees—coverage is available even in crisis.

Q: Can I still get an IUD at low cost?
A: Yes. Clinics will cover devices, insertion, follow-up, and removal either under ACA or through Title X/FQHC.

Summary

Despite the OBBB restrictions, contraception remains accessible for low-income individuals thanks to ACA protections, Title X programs, and FQHC support. While some providers may lose Medicaid funding temporarily, sliding-fee clinics and health centers continue to provide essential reproductive care. Staying informed and knowing where to go ensures access to contraception is achievable.

Disclaimer

This is not legal advice. Policies are evolving; state enforcement of OBBB varies. Always double‑check clinic participation and consult local healthcare advocates or legal aid for assistance.

Data Sources

• https://www.teenvogue.com/story/trumps-big-beautiful-bill-congress-traded-pap-smear-billionaires-tax-break?
• https://www.kff.org/medicaid/issue-brief/the-impact-of-medicaid-and-title-x-on-planned-parenthood/?
• https://bidenwhitehouse.archives.gov/briefing-room/statements-releases/2024/10/21/fact-sheet-biden-harris-administration-proposes-rule-to-expand-coverage-of-affordable-contraception-under-the-affordable-care-act/?
• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766783?
• https://paragoninstitute.org/wp-content/uploads/2025/05/Reconciliation_Provisions_Summary_RELEASE_V1.pdf?