This study aimed to observe contraceptive access, including types of contraceptives and level of use, among girls and young adults living in foster care following a state policy insurance change. This cohort study utilized linked, state administrative data to analyze child welfare and Medicaid claims data of 1641 female foster youth in Michigan. Oral tablets with a supply of 30 days before exhaustion was the most frequently prescribed contraceptive (77%), while injections, implants, and intrauterine devices (IUDs) that have longer periods of use before exhaustion were rarely prescribed. Longer-term use products were prescribed with decreased frequency in the Medicaid Health Maintenance Organization (HMO) period than in the Medicaid Fee for Service (FFS) period. Foster youth placed in residential care experienced greater access to contraceptive care than those placed in family-based settings (Adjusted Odds Ratio = 0.63, 95% CI = (0.56–0.72)) and those living independently (Adjusted Odds Ratio = 0.55, 95% CI = (0.48–0.64)). Those in the largest urban county had less access (Adjusted Odds Ratio = 0.81, 95% CI = (0.71–0.92)) to contraceptives than those from other counties in the State. Implications for policy and practice are discussed.

本研究旨在观察在国家保单变更后生活在寄养家庭的女孩和年轻人的避孕药具获取情况，包括避孕药具的类型和使用水平。该队列研究利用链接的州行政数据来分析密歇根州 1641 名女性寄养青年的儿童福利和医疗补助索赔数据。在衰竭前 30 天供应的口服片剂是最常用的避孕药 （77%），而在衰竭前使用时间更长的注射剂、植入物和宫内节育器 （IUD） 很少被开具处方。与医疗补助服务收费 （FFS） 期间相比，医疗补助健康维护组织 （HMO） 期间长期使用产品的处方频率较低。与被安置在家庭环境中的寄养青年相比（校正比值比 = 0.63,95% CI = （0.56–0.72））和独居家庭（校正比值比 = 0.55,95% CI = （0.48–0.64）），被安置在寄宿照料中的寄养青年更容易获得避孕护理。与该州其他县相比，最大城市县的人获得避孕药具的机会较少 （调整比值比 = 0.81,95% CI = （0.71–0.92））。讨论了对政策和实践的影响。