Characterization of Medicaid policy for immediate postpartum contraception

Michelle H. Moniz*, Vanessa K. Dalton, Matthew M. Davis, Jane Forman, Bradley Iott, Jessica Landgraf, Tammy Chang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Objective Long-acting reversible contraception (LARC) is safe, effective and cost-saving when provided immediately postpartum but currently underutilized due to nonreimbursement by Medicaid and other insurers. The objectives of this study were to (a) determine which state Medicaid agencies provide specific reimbursement for immediate postpartum LARC and (b) identify modifiable policy-level barriers and facilitators of immediate postpartum LARC access. Study Design We conducted semistructured telephone interviews with representatives of 40 Medicaid agencies to characterize payment methodology for immediate postpartum LARC. We coded transcripts using grounded theory and content analysis principles. Results Three categories of immediate postpartum LARC payment methodology emerged: state Medicaid agency (a) provides separate or increased bundled payment (n = 15), (b) is considering providing enhanced payment (n = 9) or (c) is not considering enhanced payment (n = 16). Two major themes emerged related to Medicaid decision-making about immediate postpartum LARC coverage: (a) Health effects: States with payment for immediate postpartum LARC frequently cited improved maternal/child health outcomes as motivating their reimbursements. Conversely, states without payment expressed misinformation about LARC's clinical effects and lack of advocacy from local providers about clinical need for this service. (b) Financial implications: States providing payment emphasized overall cost savings. Conversely, states without reimbursement expressed concern about immediate budget constraints and potential adverse impact on existing global payment methodology for inpatient care. Conclusions Many states have recently provided Medicaid coverage of immediate postpartum LARC, and several other states are considering such coverage. Addressing misinformation about clinical effects and concerns about cost-effectiveness of immediate postpartum LARC may promote adoption of immediate postpartum LARC reimbursement in Medicaid agencies currently without it. Implications Medicaid policy for reimbursement of immediate postpartum LARC is evolving rapidly across the US. Our findings suggest several concrete strategies to remove policy-level barriers and promote facilitators of immediate postpartum LARC.

Original languageEnglish (US)
Pages (from-to)523-531
Number of pages9
JournalContraception
Volume92
Issue number6
DOIs
StatePublished - Dec 1 2015

Keywords

  • Immediate postpartum contraception
  • LARC
  • Long-acting reversible contraception
  • Medicaid
  • Reimbursement

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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