Final Report on Expanding Access to Women’s Reproductive and Maternal Health Services in Vermont

FINAL REPORT August 2026 Expanding Access to Women’s Reproductive and Maternal Health Services in Vermont Presented by: NORC at the University of Chicago Presented to: Vermont Department of Financial Regulation

Expanding Access to Women’s Health in Vermont i FINAL REPORT | August 2026 Table of Contents Executive Summary..................................................................................................................1 Introduction...............................................................................................................................4 Methods.....................................................................................................................................5 Consumer Complaints and Health Plan Documents........................................................6 Survey and Claims Data ..................................................................................................7 Key Informant Interviews and Focus Groups ...................................................................7 Analysis of Existing Data Sources..........................................................................................8 Prenatal and Postnatal Care............................................................................................8 Contraceptive Care and Family Planning.........................................................................9 Behavioral Health.............................................................................................................9 Preventive Cancer Screenings ......................................................................................10 Cost Share for Covered Services...................................................................................10 Focus Group Analysis............................................................................................................11 Coverage, Availability, and Access of Women’s Health Services ..................................11 Workforce and Provider Availability ...............................................................................12 Administrative, Financing, and Billing Barriers...............................................................13 Social Determinants of Women’s Health Care...............................................................15 Recommendations for a Communications Campaign....................................................15 Conclusion..............................................................................................................................17 References ..............................................................................................................................19 Appendices .............................................................................................................................22 Appendix A: BRFSS Tables – Vermont Compared to National Results.........................22 Appendix B: Claims Data Analyses................................................................................28

Expanding Access to Women’s Health in Vermont 1 FINAL REPORT | August 2026 Executive Summary Background. By many measures, Vermont’s health system is often ranked as one of the best for women’s health care.1–3 The Commonwealth Fund and America’s Health Rankings awarded Vermont second in the nation for women’s health care, and March of Dimes ranked Vermont second in the nation based on maternal and infant health indicators.1,2 Vermont is also a leading state when it comes to passing legislation to protect women’s access to health care. For private insurance plans subject to state regulation, the state has enacted some of the strongest protections in the country, including requirements for insurers to cover all Food and Drug Administration-approved contraceptive methods, over-the-counter options, and a full 12-month supply of prescription contraception, as well as policies permitting pharmacists to provide contraceptive care and prohibiting insurer-imposed restrictions that delay access. Some of these protections, especially coverage of preventive services, are also required under federal law and apply to many health plans beyond those regulated by Vermont. However, Vermont experiences structural and operational health care challenges that impact access to care, such as a growing workforce shortage, facility closures, rural geography, and errors in claims processing. Project Purpose. In 2024, the State of Vermont was awarded funding from the Expanding Access to Women’s Health Grant through the Centers for Medicare and Medicaid Services (CMS) to improve access to essential women’s health services across the state. The Vermont Department of Financial Regulation (DFR) contracted with NORC at the University of Chicago (NORC) to 1) conduct a broad health insurance market scan to understand the current landscape for and barriers to access to women’s health services in Vermont and identify options for improving access, and 2) design and implement an audience-centered outreach and education campaign to support these efforts. This report summarizes findings from the first phase of this project. Methods. NORC conducted a mixed-methods study to assess women’s access to reproductive and maternal health services through commercial insurance in Vermont. The study focused on maternity and newborn services, abortion, contraception care, and women’s preventive health services and Report Snapshot • Vermont has strong statutory protections for women’s health but should address implementation gaps that can undermine access. • Persistent inequities, especially by race, income, and geography, limit equitable access to care. • Workforce shortages and facility closures pose a threat to access, especially in rural areas. • Administrative complexity and low reimbursement rates strain providers and affect care delivery. • A coordinated communications effort is essential to help Vermonters use available benefits and navigate the system.

Expanding Access to Women’s Health in Vermont 2 FINAL REPORT | August 2026 screenings. The analysis included a rapid review of consumer complaints and health plan documents, a review of quantitative data (survey data and claims data), and key informant interviews (KIIs) and focus groups with key stakeholders. Findings from an Analysis of Existing Data Sources. An analysis of health plan documents, publicly available reports, and survey data assessed which reproductive services are being accessed, and by whom. Measures included prenatal and postnatal care, contraceptive use and family planning, behavioral health, and preventive cancer screenings. Across these measures, findings include: • Overall, most Vermont women report that they can afford care when they need it, though those with lower income were less able to do so. • The Commonwealth Fund’s 2024 report rated Vermont has one of the best states for accessing prenatal and postpartum care2; however, the rate of inadequate prenatal care (patient received less than 50% of expected prenatal services) among Black women in Vermont is 2.7 times higher than the state average.1 • Women in Vermont who do not use pregnancy prevention or contraception do so largely with the intention to get pregnant. • Abortion care in Vermont remains broadly accessible and strongly protected under state law. The abortion rate has remained relatively stable over recent years, and most procedures continue to occur early in pregnancy (81% within the first 9 weeks). • While rates of depression are higher among Vermont women before or during pregnancy, Vermont women are screened for depression and anxiety around the time of pregnancy more often than women in other states. • Measures of preventive screenings in Vermont are similar to national levels, with performance varying by screening type and timing. Younger women and women with a lower income report more infrequent preventive care screenings. Racial and ethnic disparities are also evident within Vermont’s preventive screening data. • Based on a limited analysis of claims data, insurance companies are covering most of the required procedures that we examined without cost share. Procedures with lower rates of full insurance payment include pregnancy tests for contraceptive insertion (84% of claims had zero patient cost associated), comprehensive STI panels (85% of claims had zero patient cost associated), and lactation counseling (88% of claims had zero patient cost associated). Findings from Focus Group Analysis. Interviews with professionals regarding access to women’s health illuminated the following barriers and challenges that inhibit access to services: • Insurance companies cover legally required services without cost sharing (per Affordable Care Act and Vermont law4 and regulation for state-regulated plans); however, patients lack clear information about which benefits are legally required to be provided without cost sharing and what their specific plans cover.

Expanding Access to Women’s Health in Vermont 3 FINAL REPORT | August 2026 • Some reproductive health services, such as lactation consultants and doulas, are underutilized. Participants attributed inconsistent coverage and payment restrictions as contributing factors to underutilization. • Access to a full 12-month supply of birth control dispensed at once is legally required by Vermont law4,5,for state-regulated plans, but Vermont women have experienced challenges obtaining this benefit. • Vermont is experiencing loss of reproductive health providers and facilities, which causes patients to travel farther for care and increases burden for remaining providers. • Reimbursement rates, particularly for women’s reproductive health and mental health services, that fail to cover the total cost of delivering these services, leaving clinics to absorb financial losses. • Challenges throughout the claims process – including lack of provider knowledge about varying health plans and errors in claims processing – inhibit patients from receiving care in compliance with state mandates (when applicable). • Transportation and long travel times to facilities is a top concern for accessing health services across Vermont, in both rural and urban areas. Implications for Communications Campaign. Phase 1 findings show that many Vermonters lack clear information about what women’s health services are covered, where to access them, and how to navigate insurance coverage issues. Phase 2 should focus on improving public awareness of coverage protections and available services, with targeted outreach to populations experiencing the largest disparities. Strengthening provider and consumer understanding of coverage rules should help ensure women can fully use the benefits and protections already in place. Conclusion. These findings identify strengths and gaps within Vermont’s women’s health services system. These findings will inform a communications campaign in Vermont (Phase 2 of this project) focused on: 1) what women’s health services are required to be covered at low or no cost; 2) where and how to access women’s health services across the state; and 3) how to file a complaint if you are billed incorrectly for these services.

Expanding Access to Women’s Health in Vermont 4 FINAL REPORT | August 2026 Introduction Demographics of Women in Vermont. Women make up approximately 50% of the population in Vermont, and are predominantly White (89%).6 Almost half of women in Vermont (48%) have an income over 400% of the federal poverty level.6 Women in Vermont tend to be older, with 43% of women between the ages of 35-54 and 26% between the ages of 55-64.6 Nearly half of women in the state (49.7%) live in rural areas.7 A total of 33% of babies were born to women who live in rural counties8, while 25% of maternity care providers practice in rural counties in Vermont.8 Almost all women in Vermont report having health insurance, with a total of 97% of Vermont women ages 19-64 reporting coverage in 2022 compared to 90% nationally.2 Approximately 64% of women ages 19-64 are covered through employer-sponsored insurance, 22% by Medicaid, 9% by non-group insurance, and 2% from other sources of coverage including Medicare and TRICARE.9 In 2023, the percent of women on private insurance remained relatively stable before, during, and after pregnancy, whereas, women using Medicaid increased from 34% before pregnancy to 43% during and after pregnancy.10 Vermont’s women’s health services are strong, yet structural and operational barriers exist. By many measures, Vermont’s health system is often ranked as one of the best states for women’s health care.1–3 The Commonwealth Fund’s 2024 scorecard and in America’s Health Rankings’ 2025 report ranked Vermont second in the nation for women’s health care, and in 2025 March of Dimes scored Vermont second in the nation based on maternal and infant health indicators. 1,2 Across indicators, Vermont scored highest on measures of women’s insurance coverage,2,3 maternal mortality outcomes,2 prenatal care,1,2,11 and postpartum care.2,3 Vermont is also a leading state when it comes to passing legislation to protect access to women’s health care. The state has enacted some of the strongest protections in the country, including requirements for state-regulated health plans to cover all Food and Drug Administration-approved contraceptive methods, over-the-counter options, and a full 12-month supply of prescription contraception, as well as policies permitting pharmacists to provide contraceptive care and prohibiting insurer-imposed restrictions that delay access.4 Vermont law also mandates that survivors of sexual assault have the right to receive a medical forensic exam and related testing at no cost (irrespective of if they choose to cooperate with law enforcement), the right to consult with a sexual assault advocate, and the right to information about protections and financial support.12 State constitutional protections also ensure access to abortion and reproductive autonomy.13 However, Vermont experiences structural and operational overall health care challenges that impact access to care. Growing workforce shortages, facility closures such as hospital birthing centers, and a steady decline of local service availability limit access to women’s health services, especially in rural areas.14,15 Complicated insurance billing procedures and inconsistent claims processing can further contribute to providers’ inability to deliver the services mandated by ACA and state law (in plans subject to Vermont insurance regulation). 16 These implementation issues, rather than the absence of

Expanding Access to Women’s Health in Vermont 5 FINAL REPORT | August 2026 protective legislation, continue to hinder Vermonters’ access to comprehensive reproductive and preventive health services, particularly in areas such as contraceptive coverage, timely access to abortion, and related reproductive health services. Project Purpose. In 2024, the State of Vermont was awarded funding from the Expanding Access to Women’s Health Grant through the Centers for Medicare and Medicaid Services (CMS) to improve access to essential women’s health services across the state. This opportunity offers states support for planning and implementation of activities to enhance access to reproductive and maternal health services. DFR contracted with NORC to 1) conduct a broad Vermont health insurance market review to understand the current landscape for and barriers to access to women’s health services. and identify options for improving access, and 2) design and implement a targeted, audience-centered outreach and education campaign to support these efforts. This report summarizes findings from the first phase of this project. It begins with an overview of the project methods and data sources, followed by the findings. The findings include suggestions for the second phase of the project – the communications campaign. The report ends with a brief conclusion, references, and appendices with data tables. Methods NORC conducted a mixed-methods study to assess women’s access to reproductive and maternal health services through commercial insurance in Vermont from August 2025 through January 2026. The study focused on maternity and newborn services, abortion, contraception care, and women’s preventive health services and screenings. The analysis included a rapid review of consumer complaints and health plan documents, a review of quantitative data (survey data and claims data), and key informant interviews (KIIs) and focus groups with key stakeholders (described below). These data sources were used to answer five research questions that were developed for this study. Exhibit 1 below shows research questions, along with the data sources that answer each question. Regulatory scope. Vermont insurance coverage mandates apply only to health plans regulated by the Vermont Department of Financial Regulation. Self-funded employer health plans (with the exception of municipal employees) are governed by the federal Employee Retirement Income Security Act (ERISA) and are not subject to Vermont insurance laws. However, these plans still have to follow certain federal requirements, such as coverage for preventive services under the Affordable Care Act (ACA). Some of the services discussed in this report, particularly the preventive services such as contraception, cancer screenings, and well-woman visits, are required to be covered under federal law (e.g., the ACA), and therefore apply to many plans beyond those regulated by the state. When this report refers to ““Vermont law” or “state mandates”, it is only talking about plans that are regulated by the state.

Expanding Access to Women’s Health in Vermont 6 FINAL REPORT | August 2026 Exhibit 1. Research Questions and Data Sources Research Question Consumer Complaints and Health Plan Documents Survey and Claims Data Key Informant Interviews and Focus Groups What reproductive services are being accessed, and by whom? X X What are consumers’ experiences accessing care, including barriers? X What policies, laws, and regulations hinder access to reproductive services in Vermont? X X What information gaps exist related to reproductive health access? (To inform Project 2) X Where do women seek information about reproductive health care services? (To inform Project 2) X Consumer Complaints and Health Plan Documents NORC conducted a rapid review of documentation that assesses access to Vermont’s reproductive and maternal health services throughout a woman’s lifespan—including access to care and preventive services. The review focused on identifying key gaps, themes, and opportunities for improvement within women’s health services in Vermont. Sources included preexisting analyses; insurance plans, policies, and certificates of coverage; and de-identified consumer complaints. De-Identified Consumer Complaints. NORC and DFR worked together to review de-identified consumer complaints related to women’s reproductive, maternal, and preventive health services from the Vermont Office of the Health Care Advocate and DFR. However, both offices indicated that there were a very small number of complaints related to these specific services and that the available data could not be shared due to concerns that individuals could still be identifiable, even when data was in de-identified form. Insurance Plans, Policies, and Certificates of Coverage. NORC conducted a review of available insurance plan documents, including certificates of coverage and provider billing guides, as well as a review of state policies regarding health insurance coverage of women’s health procedures. Publicly Available Reports. NORC conducted a scan of state reports and data, such as Pregnancy Risk Assessment Monitoring System (PRAMS) and Healthy Vermonters, along with other publicly available assessments and indicators of women’s health in Vermont.

Expanding Access to Women’s Health in Vermont 7 FINAL REPORT | August 2026 Survey and Claims Data To assess health-related risk behaviors, chronic health conditions, the use of preventive services and other women’s health services, NORC analyzed publicly available national survey data and Vermont’s claims data. Survey Data. NORC conducted a descriptive analysis of Behavioral Risk Factor Surveillance System (BRFSS) data using the publicly available national dataset for 2024. NORC looked at the distribution of key women’s health variables including questions on health care access and affordability, diagnoses of chronic conditions, breast and cervical cancer screenings, and family planning practices. NORC restricted analyses to women in Vermont who have private insurance, including those who purchased a plan through an employer or union, or a private nongovernmental plan on their own, and, when applicable, compared to the same universe of insured women nationally. The data was weighed using the final sampling weight and accounted for the complex design with strata and primary sampling units. NORC compared the weighted frequencies in the Vermont sub-sample to national rates, as well as explored disparities in the key outcomes by age, race, income, and education level. Claims Data. NORC worked closely with DFR analysts to conduct an analysis of a subset of claims data from January – December 2023 using the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES). The analysis focused on 95 key women’s health services, covering maternal health, pre- and post-natal care, contraceptive care, and preventive screenings, and was limited to women covered by private insurance. The universe of claims only included paid claims, as the VHCURES database does not include denied claims. All services included in the claims analysis are legally required to be covered with no cost share (with few exceptions), per federal and state law. Vermont cannot require self-funded ERISA plans to submit data to VHCURES, therefore analysis reflects predominantly state-regulated plans.1 The analysis included conducting a quality review of the information claims contained, followed by a descriptive analysis of the number of claims, number of beneficiaries, the number of claims in which any patient cost-share was applied, the plan payment amount, and the patient cost share payment amount. Key Informant Interviews and Focus Groups NORC conducted six focus groups and one key informant interview with stakeholders—including insurers, clinicians, healthcare administrators, public health clinic staff, and public health professionals—to better understand the barriers women in Vermont face when accessing reproductive and maternal health services, as well as opportunities to improve access. Interviews were held virtually between October and December 2025. Interview notes were coded thematically and summarized. 1 Following Gobeille v. Liberty Mutual Insurance Co., 577 U.S. 312 (2016), Vermont cannot require self-funded ERISA plans to submit data to VHCURES.

Expanding Access to Women’s Health in Vermont 8 FINAL REPORT | August 2026 Analysis of Existing Data Sources To assess which reproductive services are being accessed, and by whom, we focused our assessment on measures that were available in our target data sources, and topics that were defined in the broad scope of the project, which included prenatal and postnatal care, contraceptive use and family planning, behavioral health, and preventive cancer screenings. The analysis of existing data sources includes findings from the rapid document review and survey data. As shown in the paragraphs below, Vermont ranks highly among other states across all the measures we assessed, however disparities exist among subgroups. Overall, most Vermont women surveyed report that they can afford care when they need it, though those with lower income were less able to do so. When asked if there was a time within the past 12 months when you needed to see a doctor but could not because you could not afford it, 7% of Vermont women with private health insurance responded yes, lower than the national results where 11% responded yes. Within Vermont, affordability barriers to seeing a doctor were more often reported among women with private insurance ages 25–34 and those earning <$25K, while college graduates more often reported being able to afford care. Prenatal and Postnatal Care The Commonwealth Fund’s 2024 report rated Vermont has one of the best states for accessing prenatal and postpartum care, however disparities remain.1–3 The proportion of Vermont women who receive adequate prenatal care (as defined by the Adequacy of Prenatal Care Utilization Index which classifies prenatal care received into one of four categories (inadequate, intermediate, adequate, and adequate plus) by combining information about the timing of prenatal care, the number of visits, and the infant's gestational age17,18) exceeds both the national average and the Healthy People 2030 target (in 2024 87% of live births were to women receiving adequate/adequate plus prenatal care).17 However, the rate of inadequate prenatal care (patient received less than 50% of expected prenatal services) among Black women in Vermont is 2.7 times higher than the state average.1 Most postpartum women in Vermont receive a postpartum checkup. In 2023, 93% of Vermont women had a postpartum checkup following delivery, compared to a national average of 90%.10,19 During postpartum visits, Vermont women most often discussed birth control methods (93%), medical warning signs (62%), and how long to wait before another pregnancy (61%).10 Key Opportunity Black women in Vermont are less likely to receive adequate prenatal care than average.

Expanding Access to Women’s Health in Vermont 9 FINAL REPORT | August 2026 Contraceptive Care and Family Planning Women in Vermont are more likely to use Intrauterine Devices (IUD)s than women in other states. Privately insured women in Vermont are more likely than women nationally to report having taken measures to prevent pregnancy during the last time they had sexual intercourse (89% of Vermont women compared to 82% of the national sample). When asked about what type of protection was used, privately insured Vermont women were more likely to have reported using an IUD (28% in Vermont compared to 19% in the national sample). Women in Vermont who do not use pregnancy prevention or contraception do so largely with the intention to get pregnant. Among those women with private insurance who indicated why they chose not to do anything to prevent pregnancy the last time they had sexual intercourse, Vermont women were more likely than the national sample to report that they wanted a pregnancy (54% of Vermont women compared to 31% of the national sample). Respondents in the 18-24 age group all reported using a pregnancy prevention method or contraception during their last intercourse. Among those that reported non-use, rates were higher among women ages 25–34 and those earning <$50,000. Abortion care in Vermont remains broadly accessible and strongly protected under state law. Abortion is legal in Vermont with no gestational limits, protections established in state statute and reinforced by a 2022 constitutional amendment affirming reproductive autonomy.13 In 2023 an estimated 1,015 abortions were provided in the state, with most occurring through in-person care (80%) and the majority using medication abortion (81%).20,21 The abortion rate has remained relatively stable over recent years, and most procedures continue to occur early in pregnancy (81% within the first 9 weeks).20 Behavioral Health Rates of depression are higher among Vermont women before or during pregnancy. Vermont women with private insurance reported greater rates of diagnoses of a depressive disorder (30%) compared to the national respondents (26%). Vermont women are more likely to report signs of depression, before or during pregnancy, than women in other states.2,22 Among Vermont women who are pregnant, those under 25, enrolled in Medicaid, and who do not have a high school diploma are more likely to experience depression.23 While rates of depression are higher, Vermont women are screened for depression and anxiety around the time of pregnancy more often than women in other states. National data indicates Vermont women may be more likely to be screened for depression during pre and post-natal visits compared to women in other states.2 In 2023, a high proportion of Vermont women received screening for depression and/or anxiety during (87%) and after pregnancy (89%).10

Expanding Access to Women’s Health in Vermont 10 FINAL REPORT | August 2026 Preventive Cancer Screenings Preventive screening rates in Vermont are similar to national levels. However, significant disparities exist by screening type, timing, age, income, and race/ethnicity. Varying by screening type and timing. BRFSS survey data from 2024 suggest that Vermont women with private insurance were slightly more likely than privately insured women nationally to report ever having received a cervical cancer screening (85% versus 83%). However, Vermont women were less likely than national respondents to report receiving a Human papillomavirus test at their most recent cervical cancer screening (34% versus 38%). Eighty-two percent of privately insured Vermont women reported having a mammogram within the last two years, compared to 80% of women nationally. Preventive care screening data is mixed. Cervical cancer screening increased with higher income and educational attainment, while women with lower education levels more frequently reported that their most recent screening occurred five or more years ago. Mammograms tended to be more recent among higher income respondents, not controlling for age. Pap smears were commonly reported across all age groups, while Human papillomavirus virus (HPV) testing was most commonly reported among women ages 25–54 and was less frequent among those in the $15,000–$25,000 income range and among women with only a high school diploma. Reported hysterectomy prevalence was lower in Vermont than nationally (9% versus 15%) and was slightly higher among lower income and lower education groups, not controlling for age. Racial and ethnic disparities are also evident within Vermont’s preventive screening data. The share of Hispanic women who reported having a mammogram within the past two years was markedly lower than the state average, 46% and 73% respectively.15 Reported pap smears were lower among American Indian/Alaska Native women (56%), Hispanic women (60%), and women of other races (61%) compared to white women (68%).15 Hispanic women in Vermont were also substantially less likely to report having a personal health care provider or to have seen a doctor within the past year due to cost compared to state averages.15 Cost Share for Covered Services NORC and DFR’s exploratory claims analyses found low incidence of cost-share being incorrectly applied to key women’s reproductive, maternal, and preventive health services (see Appendix B). Services including well-woman visits, contraceptive implant insertion, gestational diabetes screenings, and contraceptive office visits had few claims where the patient bore any cost share (between 98-99% of claims had no cost share to the patient). Services where there may be concern for a more systemic issue include pregnancy tests for contraceptive insertion (84% of claims had zero patient cost Key Opportunity There are disparities in preventive screening among women in Vermont by screening type, timing, age, income, and race/ethnicity.

Expanding Access to Women’s Health in Vermont 11 FINAL REPORT | August 2026 associated), comprehensive STI panels (85% of claims had zero patient cost associated), and lactation counseling (88% of claims had zero patient cost associated). However, results should be interpreted with considerations to the methods.2 DFR should consider using its authority to implement market conduct exams to ensure cost sharing is not being erroneously applied. Focus Group Analysis Despite being one of the best states in the country for access to women’s health care by many metrics discussed above, interviews with professionals regarding access to women’s health illuminated barriers that women face when trying to access reproductive healthcare services, such as lactation services and Doulas. Interview participants also shared operational factors that make access difficult in Vermont along with challenges with administrative and financial structures that create further obstacles to receiving appropriate care. Coverage, Availability, and Access of Women’s Health Services Patients experience uncertainty around insurance coverage. Based on our review of certificates of coverage, insurance companies include coverage for legally required services without cost sharing (per Affordable Care Act and Vermont regulation). However, patients lack clear information about which benefits are legally required to be provided without cost sharing and what their specific plans cover, including which birth control methods are reimbursed and whether supportive services are included. One participant noted that patients delay or avoid care because they cannot determine whether they will face out-of-pocket costs. There is also a lack of clarity about what services are available within local communities. Some insurers provide educational components to support beneficiaries in understanding their health plans, such as the BlueCross BlueShield of Vermont’s Better Beginnings Program, which informs women of changes in coverage and cost when moving from an individual to a family plan. However, payers did not highlight any efforts to more broadly improve health plan literacy among beneficiaries. Lactation consultants are underutilized during the postpartum period. Several focus group participants reported that lactation consultants are an underutilized resource in Vermont. They attributed this to inconsistent private insurance coverage and payment restrictions that limit patients’ ability to seek these services. Doula access and coverage is an emerging priority in Vermont. Beginning July 1, 2026, Vermont will implement a new policy allowing for coverage of Doula services for Medicaid recipients.24,25 Focus 2 This was an exploratory analysis - NORC did not have access to individual level claims. It is possible and likely that multiple services were included on one claim, and therefore we cannot be sure what service had cost share applied. The count of patients across procedure groups will not be mutually exclusive and therefore, patients may be count twice or more. Finally, the VHCURES dataset does not include denied claims, so there could be additional financial burden on patients that is not reflected in the data.

Expanding Access to Women’s Health in Vermont 12 FINAL REPORT | August 2026 group participants noted that, while Vermont has been trying to expand access to Doulas, the training and certification requirements have not been released, and providers are unsure if payers will reimburse for Doula care. Despite these uncertainties, multiple participants identified expanding Doula access as an important workforce priority for the state. Coverage of a full 12-month supply of birth control dispensed at once is legally required by Vermont law4,5, but Vermont women have had trouble accessing it. Focus group participants attributed this to limited awareness among all levels of the health care system, including patients, providers, insurers, and pharmacists that this option exists. To address this gap, some organizations have shared educational materials such as this flier to help educate women on how to access a 12- month supply, however knowledge gaps remain. While abortion care is available, focus group participants described access as underutilized. One public health clinic representative shared that medication abortion is available in Vermont, but awareness about the availability of the service is low. Another emphasized that medication abortion via telehealth is particularly underutilized. According to the Society for Family Planning, in the first six months of 2025, 20% of abortions in Vermont occurred via telehealth, compared to 27% nationally.26 Workforce and Provider Availability Vermont faces a growing shortage of healthcare providers. Workforce losses due to retirement, a limited number of specialists, and facility closures leave many patients with limited or no local options for essential reproductive health services. Shortages are especially prevalent in primary care, perinatal, and maternal mental health. Between 2019 and 2024, Vermont experienced a 50% decrease in the number of practicing independent physicians and a 48% decrease in independent medical practices in rural areas.14 This aligns with larger rural trends, with rural America losing nearly 2,500 independent physicians and approximately 3,300 rural medical practices between 2019 and 2024.27 These shortages have contributed to longer wait times and more limited options for accessing care. A major commercial insurer in Vermont shared that their most frequent complaint received from beneficiaries is the length of time to get an appointment with providers, and that beneficiaries are having a difficult time finding specialists or getting an appointment with specialists once identified. Women’s health facility closures have left large areas of the state without local reproductive and maternal health care. Planned Parenthood has historically played a unique and substantial role in Vermont, serving as a primary provider of abortion services, sexually transmitted infections and sexually transmitted disease testing, comprehensive contraceptive counseling, pregnancy testing, screenings, and other general health services. With multiple Planned Parenthood clinics closing28, many of these services are no longer available locally, forcing patients to travel longer Key Opportunity Vermont has been experiencing loss of reproductive health providers and facilities, which causes patients to travel farther for care and increases burden for remaining providers.

Expanding Access to Women’s Health in Vermont 13 FINAL REPORT | August 2026 distances for care. One participant from the health care administration focus group shared that there are currently no Planned Parenthood clinics in the northern half of the state and that these closures have directly impacted people’s perceived access to labor and delivery services. Additionally, the closure of Planned Parenthood clinics may cause other clinics to face increased patient demand and absorb a broader range of services with already limited capacity – for example, Federally Qualified Health Centers would need to expand contraceptive-care caseloads by 56%.29 Participants expressed desire for Vermont women to have a clearer understanding of where they can access contraceptive care, including emergency contraception. The closure of labor and delivery units and independent OB/GYN clinics further complicates Vermont’s reproductive health system, reducing options for prenatal, delivery, and specialty reproductive care. Recently, the Copley Hospital Birthing Center in Morrisville, Vermont, Lamoille County’s only inpatient birthing unit, closed permanently on November 1, 2025, due to declining birth rates and financial losses.30 Facility closures and workforce shortages disrupt referral pathways and complicate communication between providers, making care coordination more difficult. Facility closures further disrupt system navigation and often require individuals to seek care across multiple counties and potentially cross state lines. Many clinical and social supports, such as home visiting programs, lactation services, and community-based resources, are not clearly integrated into care – leaving patients lacking guidance as they progress through prenatal, delivery, and postpartum care. Administrative, Financing, and Billing Barriers Low reimbursement rates and other financial constraints contribute to clinic revenue loss, service line closures, and workforce shortages. Participants emphasized that reimbursement rates often fail to cover the actual cost of delivering these services, leaving clinics to absorb financial losses. For example, the Blueprint Pregnancy Intention Initiative (PII) is an innovative reproductive health model that has successfully secured Medicaid reimbursement with an intention to expand to commercially insured patients. However, reimbursement alone does not adequately cover provider salaries and costs of care provided through this program. Many providers rely on the 340B Drug Pricing Program to purchase supplies and drugs at discounted prices to help offset procedure costs for IUDs and contraceptive implants. One participant noted that at their clinic, vasectomies are among the highest-reimbursed services, demonstrating the undervaluing of essential reproductive and maternal health services.

Expanding Access to Women’s Health in Vermont 14 FINAL REPORT | August 2026 Challenges within provider-payer relationships affect reimbursement, contracting, and the administrative burden of delivering women’s health services. Some participants perceived that insurance providers hold most of the negotiating power in the current relationship dynamic, which contributes to insufficient reimbursement rates for health providers. Negotiation and billing processes can also be lengthy and require technical knowledge, which causes additional strain on providers with limited capacity. These participants called for increased regulations and oversight to balance the provider-payer relationship. Other participants noted that insurers provide support for providers, such as monthly informational newsletters, notification of policy changes, and provider relations teams to work directly with providers. Challenges throughout the claims process affect compliance with state mandated coverage and patient’s payments for their health services. There are multiple stages of the claims process that affect how a patient receives and pays for their services. First, focus group participants emphasized that it is nearly impossible for providers to know which services are covered and reimbursed by which insurers, even when certain benefits are mandated by law. This lack of clarity is particularly pronounced around diagnostic mammography, dense breast cancer screening, and contraceptive methods. Participants noted that providers may also be reluctant to refer patients to supportive services or other community-based resources due to uncertainty of what insurance will cover. Providers also experience challenges when coding and billing for services rendered. Participants identified challenges with using existing code structures to accurately bill for services. For example, providers currently code a visit for pain associated with an IUD misplacement as the primary complaint of “pain,” which fails to capture the underlying cause of the visit and can result in the service not being recognized or covered as IUD-related care. Providers may face additional issues due to inconsistent insurer practices and unclear coverage determinations across payers. Lastly, errors in processing may result in patients overpaying for services. An investigation into state￾regulated health plan contraceptive coverage in Vermont found that insurance companies were incorrectly processing claims to include a member cost share due to incorrect coding, unclear interpretations of the contraceptive coverage mandate, and system limitations. The audit of contraceptive claims from October 1, 2017 to September 30, 2021, which was conducted by DFR, found that 9,826 members were affected by the incorrect processing of claims, leading to over $1.5 million incorrectly charged and returned to members.16 Once DFR identified claims that required restitution, the insurers issued checks to the members that included the cost share payment plus statutory interest. Furthermore, DFR has required quarterly insurer audits to ensure corrective actions from the Order related to this area are working as intended and that claims systems are correctly applying cost sharing. Key Opportunity Reimbursement rates, particularly for reproductive health and mental health services, often fail to cover the total cost of delivering these services, leaving clinics to absorb financial losses.

Expanding Access to Women’s Health in Vermont 15 FINAL REPORT | August 2026 Insurance policy requirements at times limit women’s use of covered services. Coverage of women’s health services tends to be robust in Vermont, but insurance rules may impact utilization.31 For example, some plans implemented medical management techniques requiring a patient to be seen at a certain frequency (e.g., every three years) to be considered an established patient, which may differ from recommended frequency of routine preventive care (e.g., Pap smears are recommended every three to five years). One provider emphasized their goal to ensure patients are seen by the right provider at the right time. Social Determinants of Women’s Health Care Long distances and transportation barriers limit access to women’s reproductive health care services in rural Vermont. Vermont’s rural geography, compounded by facility closures and loss of healthcare workforce, causes patients to travel long distances even for routine services. On average, women in Vermont travel 14.7 miles to their nearest birthing hospital, and in maternity care deserts that distance increases to 20.7 miles.8 Focus group participants noted that there is only one fetal medicine group in the state, located in Burlington, requiring all high-risk patients to travel there or to Dartmouth to receive care. For individuals without reliable transportation, these distances can make care unreachable – particularly due to a lack of public transportation in the state. Although organizations like the University of Vermont have robust care management teams that assist patients in accessing community resources, including transportation, many individuals face additional barriers such as childcare coverage or senior-care duties that make long trips difficult. A participant from a public health clinic noted that even for those located in Burlington, Vermont’s largest city, public transportation is still a major obstacle to accessing obstetric services, underscoring the even greater impact of rural clinic closures for those living outside of urban hubs. Several participants noted that telehealth is an underutilized service to bridge some of these gaps, though internet access is not universal across all areas of the state. Recommendations for a Communications Campaign This section summarizes what focus group participants and interviewees suggested when asked specifically about the kinds of information and messaging that could help address these gaps through a communications campaign, closely reflecting the themes that surfaced throughout the sections above. Key Opportunity Transportation and long travel times to facilities are top concerns for accessing health services across Vermont, in both rural and urban areas. Telehealth is underutilized in bridging these gaps.

Expanding Access to Women’s Health in Vermont 16 FINAL REPORT | August 2026 Communicate what health care services are provided and covered in Vermont. Participants discussed how a communications campaign could promote Vermont’s continuum of care for women by raising awareness of the range of health services available and covered in Vermont, including types of contraceptive care, medication abortion, counseling, and screening, and where to access these services. Participants encouraged messaging that promotes telehealth options and when telehealth services may be appropriate. While many women’s health campaigns focus on pregnancy and newborn services, participants encouraged messaging that also focuses on maintaining routine preventive care of new parents. Participants identified needs for improving public education on women’s health topics, such as public messaging that counteracts misinformation about women’s health. BlueCross BlueShield led a Know Before You Go campaign, which included a checklist for patients to prepare ahead of a care visit. There may be opportunities to address gaps in care for postpartum conditions such as psychosis and birth-related trauma, which may be overlooked and have limited treatment options. There may also be opportunities to improve awareness about types of specialty services available. Communicate what legal protections exist and how to report issues. Participants highlighted the importance of empowering women to speak up, ask questions, and report issues when needed. Participants identified a need for communications related to legal coverage requirements (e.g., Affordable Care Act and state law requirements), coverage across insurance carriers, and estimated costs for services, which may help women to identify when there are problems with their coverage or health care claims. Communications may also identify appropriate contacts and explain how to report a coverage or health care claim issue. For example, the Vermont Department of Health may consider signage for women's health care sites that proclaim women’s rights and current legal protections, similar to hospital signage about the Emergency Medical Treatment and Active Labor Act. Planned Parenthood of Northern New England has prepared some similar resources on Vermont’s Access to Birth Control Law and How to Get a Free, One-Year Supply of Birth Control Under Vermont Law. Key Opportunity Women in Vermont can benefit from increased communications about:

1. what women’s health services are covered at low or no cost;
2. where and how to access women’s health services across the state; and
3. how to file a complaint if your insurance bills you incorrectly for these services. Key Opportunity Further research and educational efforts are needed to bridge gaps in care for postpartum conditions, especially mental health.

Expanding Access to Women’s Health in Vermont 17 FINAL REPORT | August 2026 Communicate what supportive services are available in Vermont communities. Participants encouraged communications related to support services and community-specific resources be made available. For example, Vermont 211 is an information and referral database that provides a directory of community services and a hotline that can facilitate referrals. Communicate to providers. Participants identified needs for improving provider education on women’s health topics. This may include provider training on topics like 12-month prescription fills for contraceptives and appropriate coding and billing of services. For example, practitioners may benefit from learning how to improve coding of services to avoid cost sharing, as intended by ACA and state law. Effective dissemination of a women’s health services campaign includes a mix of channels and messengers. Participants noted that effective dissemination channels for public women’s health messaging may include social media (particularly Tik Tok), radio, podcasts, online forums, and local news outlets. Audiences may also rely on internet search engines to identify services and information. Participants also identified providers (including Planned Parenthood and pharmacies), community partners (e.g., Vermont Parent Child Centers and Perinatal Quality Collaborative Vermont). For example, Vermont Department of Health previously leveraged pharmacists to post public service bulletins and other printed materials. Conclusion Vermont’s women’s health services system demonstrates many strengths, including high rates of insurance coverage, strong performance on maternal and postpartum care, and national leadership on several women’s health indicators. Compared to national benchmarks, Vermont women report relatively fewer affordability barriers and higher engagement in preventive and reproductive health behaviors, including cervical cancer screening and contraceptive use. These findings reflect the state’s longstanding investments in coverage protections, public health infrastructure, and maternal health initiatives. At the same time, this assessment highlights persistent and emerging gaps in access to care despite comprehensive reproductive and preventive health services protections from ACA and the state. Physical access challenges driven by rural geography, provider shortages, and service closures continue to limit timely and equitable access—particularly for specialized, perinatal, and behavioral health services. Disparities by age, income, education, and race indicate that access is not evenly distributed across the state, with some populations experiencing greater difficulty obtaining preventive care, family planning services, prenatal care, and mental health support. Confusion around insurance coverage and challenges throughout the claims process further compound these barriers, placing additional burden on both patients and providers and contributing to delayed or forgone care. The findings underscore the need for a coordinated, system-level approach to improving access to women’s health services in Vermont. Strengthening care coordination, reinforcing the women’s health workforce, improving clarity and consistency in coverage and reimbursement, and investing in

Expanding Access to Women’s Health in Vermont 18 FINAL REPORT | August 2026 innovative care models, particularly those that serve rural and underserved communities, will be critical to sustaining Vermont’s strong performance while addressing areas of unmet need. The current approach places the burden on both patients and providers to identify, request, and connect women to additional support services, meaning many women who could benefit never receive them. However, if all eligible women are automatically connected to available services and supports, with the option to decline, this would expand access and ensure more consistent use of available supports. Targeted communication and education efforts can further empower women, providers, and communities to fully utilize available services and legal protections. These findings will inform a communications campaign in Vermont (Phase 2 of this project) focused on: 1) what women’s health services are covered with no cost sharing; 2) where and how to access women’s health services across the state; and 3) how to file a complaint if your insurance bills you incorrectly for these services.

Expanding Access to Women’s Health in Vermont 19 FINAL REPORT | August 2026 References

1. March of Dimes. 2025 March Of Dimes Report Card For Vermont. March of Dimes | PeriStats.
2. Accessed February 2, 2026. https://www.marchofdimes.org/peristats/reports/vermont/report￾card
3. Commonwealth Fund. 2024 State Scorecard on Women’s Health and Reproductive Care: Vermont.
4. Accessed January 7, 2026. https://interactives.commonwealthfund.org/2024/Womens+health+scorecard/Vermont.pdf
5. America’s Health Rankings. 2025 Health of Women and Children Report: State Summaries. 2025. Accessed February 2, 2026. https://assets.americashealthrankings.org/AHR_2025HWCReport￾StateSummaries_FINAL-WEB-ALL.pdf
6. Required Covered Benefits - Reproductive Health Care Services. tit. 8, § 4077. 2016. https://legislature.vermont.gov/statutes/section/08/107/04077
7. Vermont Access to Birth Control Law. Published online 2020.
8. Vermont Women’s Demographic Data. KFF. Accessed February 23, 2026. https://www.kff.org/interactive/womens-health-profiles/united-states/
9. Explore Rural Population in Vermont | AHR. Accessed February 13, 2026. https://www.americashealthrankings.org/explore/measures/pct_rural_b/rural_female/VT
10. Where You Live Matters: Maternity Care in Vermont. March of Dimes; 2023. https://www.marchofdimes.org/peristats/assets/s3/reports/mcd/Maternity-Care-Report-Vermont.pdf
11. Kaiser Family Foundation. Vermont Women’s Health Insurance Coverage Data. Accessed February 2, 2026. https://www.kff.org/interactive/womens-health-profiles/vermont/maternal-infant￾health/
12. Vermont Department of Health. 2023 Pregnancy Risk Assessment Monitoring System (PRAMS) Highlights. 2025.
13. America’s Health Rankings. Explore Adequate Prenatal Care in the United States. Accessed February 2, 2026. https://www.americashealthrankings.org/explore/measures/prenatalcare_adquate
14. Sexual Assault Survivors’ Rights. Vol 13. https://legislature.vermont.gov/statutes/section/13/072/03281
15. Article 22 (Proposal 5): Reproductive Liberty Amendment. 2022.
16. Rural Areas Face Steep Decline in Independent Physicians and Practices. https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI￾Avalere%20Report%20on%20Rural%20Physician%20Ownership%20Trends%20- %20final.pdf?ver=A7ouK0EF0N0_zrs1qQraOQ%3d%3d

Expanding Access to Women’s Health in Vermont 20 FINAL REPORT | August 2026 15. Lewis A. Shifts in the Vermont Public Health Workforce: Impacts Post-Pandemic and Needed Remediations. VtPHA. April 11, 2025. Accessed March 18, 2026. https://vtpha.org/shifts-in-the￾vermont-public-health-workforce-impacts-post-pandemic-and-needed-remediations/ 16. Contraceptive Services Claims Restitution Information | Department of Financial Regulation. Accessed March 18, 2026. https://dfr.vermont.gov/contraceptive-services-claims-restitution￾information 17. March of Dimes. Adequate/adeq+ prenatal care: United States, 2019-2024. March of Dimes | PeriStats. January 2024. Accessed February 13, 2026. https://www.marchofdimes.org/peristats/data?reg=99&top=5&stop=29&lev=1&slev=4&obj=1 18. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994;84(9):1414-1420. doi:10.2105/ajph.84.9.1414 19. America’s Health Rankings. Postpartum Visit by State. 2023. Accessed January 7, 2026. https://www.americashealthrankings.org/explore/measures/postpartum_visit 20. Vermont Abortion Data. KFF. Accessed February 22, 2026. https://www.kff.org/interactive/womens￾health-profiles/united-states/ 21. Vermont Department of Health. 2023 Vermont Vital Statistics. 2025. https://www.healthvermont.gov/sites/default/files/document/2023%20Annual%20Vital%20Statistics %20Report%20-%20Final.pdf 22. America’s Health Rankings. Frequent Mental Distress - Women in Vermont. Accessed February 2, 2026. https://www.americashealthrankings.org/explore/measures/mental_distress_women/VT 23. Vermont Department of Health. Pregnancy Risk Assessment Monitoring System Phase 8 Report. 2024. Accessed January 7, 2026. https://www.healthvermont.gov/sites/default/files/document/hsi￾prams-phase-8-report_6.pdf 24. Medicaid Coverage for Doula Services. Vol 33. 2025. https://legislature.vermont.gov/statutes/section/33/019/01901p 25. Coverage of Doula Services for Vermont Medicaid. Department of Vermont Health Access:54-55. https://legislature.vermont.gov/Documents/2026/Workgroups/Senate%20Health%20and%20Welfar e/Bills/S.53/Witness%20Documents/S.53~Alex%20McCracken~Doula%20Analysis%20Pages%20f rom%20DVHA%20Annual%20Report~3-14-2025.pdf 26. #WeCount report, April 2022 to June 2025. Society of Family Planning. Accessed March 17, 2026. https://societyfp.org/research/wecount/wecount-june-2025-data/ 27. PAI-Avalere Report: Rural Areas Face Steep Decline in Independent Physicians and Practices. Physicians Advocacy Institute. Accessed February 3, 2026. https://www.physiciansadvocacyinstitute.org/PAI-Research/Rural-Physician-Employment-and￾Acquisition-Trends-2019-2024

Expanding Access to Women’s Health in Vermont 21 FINAL REPORT | August 2026 28. Planned Parenthood of Northern New England to Close St. Johnsbury, Vermont Health Center. Accessed January 30, 2026. https://www.plannedparenthood.org/planned-parenthood-northern￾new-england/newsroom/planned-parenthood-of-northern-new-england-to-close-st-johnsbury￾vermont-health-center 29. Institute MOG. Federally Qualified Health Centers Could Not Readily Replace Planned Parenthood | Guttmacher Institute. May 13, 2025. Accessed February 20, 2026. https://www.guttmacher.org/news-release/2025/federally-qualified-health-centers-could-not-readily￾replace-planned-parenthood 30. Baker J. Copley Hospital Birthing Center Closure Date Announcement. Copley Hospital. June 26, 2025. Accessed February 23, 2026. https://www.copleyvt.org/copley-hospital-birthing-center￾closure-date-announcement/ 31. Centers for Medicare and Medicaid Services. FAQS ABOUT AFFORDABLE CARE ACT AND WOMEN’S HEALTH AND CANCER RIGHTS ACT IMPLEMENTATION PART 68. 2024. Accessed June 1, 2026. https://www.cms.gov/files/document/faqs-implementation-part-68.pdf

Expanding Access to Women’s Health in Vermont 22 FINAL REPORT | August 2026 Appendices Appendix A: BRFSS Tables – Vermont Compared to National Results Analyses restricted to women with commercial insurance. Question Text Response Options Vermont Weighted Percentages National Weighted Percentages Do you have one person or a group of doctors that you think of as your personal health care provider? Yes, only one 54.69 51.61 More than one 37.40 38.56 No 7.23 9.18 DK/Not sure 0.62 0.51 Refused 0.06 0.13 Was there a time in the past 12 months when you needed to see a doctor but could not because you could not afford it? Yes 7.02 10.61 No 92.87 89.22 DK/Not Sure 0.11 0.14 Refused 0 0.04 Approximately how long has it been since you last visited a doctor for a routine checkup? Within the past year 79.02 81.33 Within the past two years 9.82 10.62 Within the past 5 years 7.94 4.91 5 or more years ago 2.44 2.16 DK/Not Sure 0.68 0.66 Never 0.04 0.25 Refused 0.05 0.66

Expanding Access to Women’s Health in Vermont 23 FINAL REPORT | August 2026 Question Text Response Options Vermont Weighted Percentages National Weighted Percentages Has a doctor, nurse or other health professional ever told you that you had any of the following diagnoses… (note: only “yes” responses shown) A heart attack (myocardial infarction) 2.10 1.62 Angina or coronary heart disease 0.63 1.62 A stroke 1.01 1.59 Asthma 20.79 17.31 Skin cancer (not melanoma) 4.39 4.16 Melanoma or other types of cancer 7.54 6.44 COPD, emphysema, or chronic bronchitis 2.44 3.57 Depressive disorder 30.46 25.92 Kidney disease 1.46 2.27 Arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia 21.77 21.38 Diabetes – yes 4.28 7.90 Diabetes – yes, but only during pregnancy 1.18 1.68 Breast and Cervical Cancer Screening Have you ever had a mammogram? Yes 60.28 62.68 No 39.45 36.95 DK/Not Sure 0.11 0.24 Refused 0.16 0.13

Expanding Access to Women’s Health in Vermont 24 FINAL REPORT | August 2026 Question Text Response Options Vermont Weighted Percentages National Weighted Percentages How long has it been since your last one? Within the past year 63.30 62.97 Within the past 2 years 18.27 17.43 Within the past 3 years 7.03 6.51 Within the past 5 years 4.84 4.81 5 or more years ago 5.67 7.15 DK/Not Sure 0.78 0.98 Refused 0.12 0.15 Have you ever had a cervical cancer screening test? Yes 85.03 82.68 No 13.33 15.12 DK/Not sure 1.40 1.91 Refused 0.23 0.29 How long has it been since your last one? Within the past year 35.43 42.85 Within the past 2 years 21.23 21.13 Within the past 3 years 15.01 12.27 Within the past 5 years 12.18 8.51 5 or more years ago 13.10 13.18 DK/Not sure 2.88 1.84 Refused 0.18 0.22 At your most recent cervical cancer screening, did you have a Pap test? Yes 94.74 93.12 No 3.52 4.51 DK/Not sure 1.55 2.19 Refused 0.19 0.17

Expanding Access to Women’s Health in Vermont 25 FINAL REPORT | August 2026 Question Text Response Options Vermont Weighted Percentages National Weighted Percentages An HPV test? (HPV = Human papillomavirus) Yes 34.34 37.50 No 43.54 38.94 DK/Not sure 21.26 23.34 Refused 0.85 0.22 Have you had a hysterectomy? Yes 8.79 14.93 No 90.88 84.59 DK/Not sure 0.13 0.25 Refused 0.20 0.23 Family Planning The last time you had sexual intercourse, did you or your partner do anything to keep you from getting pregnant? Yes 89.46 82.36 No 10.06 17.00 DK/Not Sure 0.48 0.12 Refused 0 0.52 The last time you had sexual intercourse, what did you or your partner do to keep you from getting pregnant? Female sterilization 5.89 8.02 Male sterilization 16.96 15.20 Contraceptive implant 5.39 2.58 Intrauterine device or IUD 27.84 19.45 Shots 0.20 0.70 Birth control pills, contraceptive ring, contraceptive patch 18.77 21.20 Condoms 14.83 17.89 Diaphragm, cervical cap, sponge, foam, jelly, film, or cream 0.23 0.01

Expanding Access to Women’s Health in Vermont 26 FINAL REPORT | August 2026 Question Text Response Options Vermont Weighted Percentages National Weighted Percentages Had sex at a time when less likely to get pregnant 1.29 1.66 Withdrawal or pulling out 4.81 7.43 Emergency contraception or morning after pill 0 0.33 Other method 2.20 2.84 DK/Not sure 0 0.44 Refused 1.6 2.24 What was your main reason for not doing anything to prevent pregnancy the last time you had sexual intercourse? You didn’t think you were going to have sex/no regular partner 0.65 1.00 You just didn’t think about it 0 4.09 You wanted a pregnancy 53.89 31.36 You didn’t care if you got pregnant 4.57 6.79 You or your partner didn’t want to use birth control 0 0.70 You had trouble getting or paying for birth control 0 0.51 You didn’t trust giving out your personal information to medical personnel 0 0.10 Didn’t think you or your partner could get pregnant 7.34 15.60

Expanding Access to Women’s Health in Vermont 27 FINAL REPORT | August 2026 Question Text Response Options Vermont Weighted Percentages National Weighted Percentages You were using withdrawal or pulling out 0 0.72 You had your tubes tied 8.67 7.33 Your partner had a vasectomy 4.16 4.14 You were breast￾feeding or you just had a baby 1.86 0.74 Other reasons 12.25 21.77 DK/Not sure 0 3.67 Refused 6.61 1.47 *DK = don’t know

Expanding Access to Women’s Health in Vermont 28 FINAL REPORT | August 2026 Appendix B: Claims Data Analyses Procedure groups Procedure codes Beneficiary count Claim count Claims per bene Claims with a $0 patient payment amount (%) Well-woman visits 99385, 99386, 99387, 99395, 99396, 99397 89,517 100,949 1.1277 100,313 (99.37) Cervical cancer screenings 87624, 87625, G0476 15,634 16,343 1.0453 14,874 (91.01) Gestational Diabetes Screenings 82947, 82950, 82951 4,028 4,278 1.0621 4,196 (98.08) Lactation Counseling 99401, 99402, 99403, 99404 35 59 1.6857 52 (88.14) Contraceptive office visits 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404 10,075 11,539 1.1453 11,319 (98.09) Contraceptive Implant 11981 1,070 1,155 1.0794 1,144 (99.05) IUD Insertion 58300, 58301 6,561 7,436 1.1334 7,385 (99.31)

Expanding Access to Women’s Health in Vermont 29 FINAL REPORT | August 2026 Procedure groups Procedure codes Beneficiary count Claim count Claims per bene Claims with a $0 patient payment amount (%) Pregnancy test for contraceptive insertion 81025, 84702, 84703 5,756 6,798 1.1810 5,731 (84.30) Chlamydia 86631, 86632, 87110, 87270, 87320, 87491, 87492, 87590, 87801, 87810 24,402 31,352 1.2848 28,612 (91.26) Gonorrhea 87590, 87591, 87592, 87801, 87850 23,886 30,662 1.2837 28,675 (93.52) HIV 86689, 86701, 86702, 86703, 87389, 87390, 87391, 87534, 87535, 87536, 87537, 87538, 87539, 87806 18,313 20,782 1.1348 19,075 (91.79) Syphilis 0064U, 0065U, 0210U, 86592, 86593, 86780 12,147 13,746 1.1316 12,808 (93.18) STI testing 87801 1,275 1,463 1.1475 1,239 (84.69) Note: Some overlap across the procedure groups is expected because a claim may be associated with more than one procedure code