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More Medicaid agencies covering contraceptive insertion immediately postpartum

Since South Carolina began providing additional payment for the insertion of long-acting reversible contraceptives immediately following delivery in 2012, at least 14 other Medicaid agencies have implemented similar policies, according to recently published data.

“Postpartum women have a high risk of unintended pregnancy, partly because less than 10% use the most effect forms of contraception. Many women’s first choice for birth control is an [intrauterine device (IUD)] or implant, which we know are the safest and most effective forms of reversible contraception. The problem is that many postpartum women can’t make it back to the office for an appointment to get one. Our findings suggest that more and more agencies recognize significant benefits to providing this service before women even leave the hospital,” Michelle Moniz, MD, MSc, assistant professor of obstetrics and gynecology at the University of Michigan Medical School, said in a press release.

Michelle Moniz

Moniz and colleagues interviewed representatives from 40 Medicaid agencies across the country to assess the proportion and characteristics of Medicaid agencies that allow specific billing for insertion of long-acting reversible contraceptives (LARC) immediately following child delivery. 

Results demonstrated that 15 agencies provided separate or increased bundled payment, nine considered providing payment in the future and 16 were not considering payment for immediate postpartum LARC insertion.

Among Medicaid agencies that were and were not considering providing reimbursement, three issues — health effects on beneficiaries, financial implications and competing demands in policy environment — were regularly related to the decision to provide LARC reimbursement. 

The health benefits of LARC insertion immediately following delivery were addressed at length from representatives of agencies providing reimbursement. However, agencies that did not provide reimbursement did not often mention health effects of beneficiaries, according to the researchers. Among those, uncertainty about the efficacy of immediate postpartum insertion was addressed. Moreover, these agencies noted that they had not been approached by clinicians about the matter.

Moniz and colleagues noted that for more agencies to provide reimbursement for immediate postpartum LARC, misconceptions about both the clinical and cost-effectiveness of LARC needs to be addressed.

“Reimbursement policies have been the biggest barrier to providing a large group of high-risk women with the safest and most effective forms of reversible birth control in a way that’s most convenient for them. We found that the landscape is changing rapidly, with more Medicaid agencies making it easier for women to get the kind of birth control they want, when they need it most. The majority of states, however, still do not provide this specific coverage, suggesting a great need to correct misinformation about immediate postpartum contraception and concerns about cost to help promote better access for more women,” Moniz said in the release. – by Casey Hower

Disclosures: The researchers report no relevant financial disclosures.