State of Access: A Contraceptive Policy Scorecard assesses policy environments in each U.S. state and the District of Columbia, illuminating where access to contraception is protected or restricted through laws affecting affordability, availability, and environment of care. For this work, we define contraception as medicines, devices, and behaviors that are used to prevent pregnancy and to manage other health conditions.
Last updated: July 14, 2025
Below are the definitions of each policy used to evaluate states in this scorecard. Definitions will display below corresponding to the specific policies selected above.
Medicaid Expansion measures whether a state has adopted and implemented Medicaid expansion under the Affordable Care Act, which extends Medicaid coverage, including contraceptive care, to residents with incomes up to 138% of the federal poverty level. This policy indicator also measures whether states have implemented trigger laws and/or work requirements for Medicaid eligibility.
Family Planning Medicaid Expansion measures whether a state has expanded eligibility for Medicaid coverage of family planning services to more residents with low income, including men and minors, through a waiver, state plan amendment, or state-funded program.
Contraceptive Coverage measures whether a state requires insurers to cover prescription and over-the-counter contraceptive methods without cost sharing.
Prescriptive Authority measures whether a state permits pharmacists, nurse midwives, and nurse practitioners to independently prescribe contraceptives to patients.
Extended Supply of Contraceptives measures whether a state requires Medicaid and private insurers to cover an extended 12-month supply of contraceptives.
Emergency Contraception measures whether a state requires emergency rooms to provide information and dispense emergency contraceptives (EC) to patients. This policy indicator also measures whether a state explicitly prohibits EC provision in state family planning programs or the contraceptive coverage mandate.
Minor Consent measures whether a state permits minors to independently access contraceptive services, including whether providers are allowed to inform their parents.
Sex Education measures whether a state mandates sex education or abstinence-plus education in schools, including whether the curriculum is medically accurate and parental consent is required.
Refusal Clauses measures whether a state permits individual providers, pharmacists, or health care institutions to refuse to provide contraceptive services for religious or moral reasons.
