Study: 10% of PCPs offer longer-acting birth control to Medicaid beneficiaries

Key takeaways:

• About half of primary care physicians who treat Medicaid patients offered oral contraceptives.
• Age, state Medicaid expansion status and specialty were associated with how physicians offered contraceptives.

Although about half of primary care physicians who treat Medicaid patients offered oral contraceptives, just 10% provided longer-acting birth control methods like intrauterine devices, according to researchers.

Mandar Bodas, PhD, a research scientist at The George Washington University — Milken Institute School of Public Health, and colleagues wrote in JAMA Health Forum that previous research has demonstrated factors like socioeconomic status, income and insurance coverage were linked to contraceptive use, but not much is known about how PCPs offer contraceptive care to Medicaid beneficiaries.

“Medicaid beneficiaries often struggle to find physicians willing to see them,” they wrote. “Nationally, approximately one-third of primary care physicians do not accept Medicaid.”

Bodas and colleagues conducted a cross-sectional study using data from the Transformed Medicaid Statistical Information System from 2016 for 251,017 physicians, 70% of whom practiced in a state that had expanded Medicaid. The physicians were from four specialties: family medicine, internal medicine, OB/GYN and pediatrics.

“This study is first of its kind and uses a national dataset of all Medicaid claims filed in the U.S,” Bodas said in a press release.

Bodas and colleagues found that, of the physicians, 48% prescribed hormonal birth control methods. However, only 10% provided longer-acting birth control methods like IUDs or implants.

“Previous research tells us that Medicaid beneficiaries face a number of barriers to accessing primary care, and our study finds that one of those barriers is lack of access to the full range of contraceptive methods,” Julia Strasser, DrPH, MPH, one of the primary investigators of the research project and director of the Jacobs Institute of Women’s Health at The George Washington University — Milken Institute School of Public Health, said in the release. “If a patient goes to a physician who is the only provider in the area that accepts Medicaid, and that physician only provides the birth control pill but not other methods, then it’s hard to say that the patient has reasonable access to all forms of contraception.”

The researchers also noted that physician- and community-level factors like age, state status of Medicaid expansion and specialty were significantly associated with how they offered Medicaid beneficiaries contraceptive services, a finding that suggests ensuring access for Medicaid beneficiaries could require different program and policy approaches tailored for the type of physician, they wrote.

Among family medicine physicians, the age groups linked to lower odds of offering implants or IUDs were:

• 45 to 54 years (OR = 0.66; 95% CI, 0.55-0.8);
• 55 to 64 years (OR = 0.51; 95% CI, 0.39-0.65); and
• 65 years or older (OR = 0.29; 95% CI, 0.19-0.44).

Additionally, practicing in a state that had expanded Medicaid by 2016 was linked to higher odds of offering hormonal contraception for both internal medicine (OR = 1.71; 95% CI, 1.18-2.48) and family medicine (OR = 1.5; 95% CI, 1.06-2.12), but not for those in other specialties.

“Understanding contraception provision by physicians has become more important in the context of recent developments in state policies on access to abortion,” Bodas, Strasser and colleagues concluded. “Over the next few years, medical students’ training on this subject is expected to be constrained by state laws on abortions. In the future, physicians may have to optimize how they prescribe contraception (by prescribing it for longer durations), assess the possibility of contraception failure among its users, and recommend the use of tools such as app-based reminders or alarms.”

References:

• Bodas M, et al. JAMA Health Forum. 2023;doi:10.1001/jamahealthforum.2023.0106.
• Few Medicaid-participating primary care physicians providing longer-acting birth control methods. https://www.eurekalert.org/news-releases/982909? Published March 17, 2023. Accessed March 16, 2023.