Abstract
Context
Long-acting reversible contraception (LARC) is the most effective reversible method
to prevent unplanned pregnancies. Variability in state-level policies and the high
cost of LARC could create substantial inconsistencies in Medicaid coverage, despite
federal guidance aimed at enhancing broad access. This study surveyed state Medicaid
payment policies and outreach activities related to LARC to explore the scope of services
covered.
Methods
Using publicly available information, we performed a content analysis of state Medicaid
family planning and LARC payment policies. Purposeful sampling led to a selection
of nine states with diverse geographic locations, political climates, Medicaid expansion
status, and the number of women covered by Medicaid.
Results
All nine states' Medicaid programs covered some aspects of LARC. However, only a single
state's payment structure incorporated all core aspects of high-quality LARC service
delivery, including counseling, device, insertion, removal, and follow-up care. Most
states did not explicitly address counseling, device removal, or follow-up care. Some
states had strategies to enhance access, including policies to increase device reimbursement,
stocking and delivery programs to remove cost barriers, and covering devices and insertion
after an abortion.
Conclusions
Although Medicaid policy encourages LARC methods, state payment policies frequently
fail to address key aspects of care, including counseling, follow-up care, and removal,
resulting in highly variable state-level practices. Although some states include payment
policy innovations to support LARC access, significant opportunities remain.
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Biography
Veronica X. Vela, MS, IEOR, DrPH(C), redesigns health care services for the Department of Veterans Affairs. She is a Human Innovation Fellow, Office of Personnel and Management Innovation Lab, and a doctoral candidate (George Washington University's Milken Institute School of Public Health).
Biography
Elizabeth W. Patton, MD, MPhil, MSc, is an Assistant Professor, obstetrician-gynecologist, and health services researcher at the Boston University School of Medicine/Boston Medical Center and the VA Boston Healthcare System.
Biography
Darshak Sanghavi, MD, is Chief Medical Officer and Senior Vice President of Translation at OptumLabs. Previously, he was the Director of Preventive and Population Health at the Center for Medicare and Medicaid Innovation within the U.S. Department of Health and Human Services.
Biography
Susan F. Wood, PhD, is a Professor of Health Policy and Management and Director of the Jacobs Institute of Women's Health, all at George Washington University. Previously she was Assistant Commissioner for Women's Health and Director of the Office of Women's Health at the FDA.
Biography
Peter Shin, PhD, MPH, is Director of the Geiger Gibson Program in Community Health Policy, RCHN Community Health Foundation Research Director, and an Associate Professor in the Department of Health Policy at the George Washington University Milken Institute School of Public Health.
Biography
Sara Rosenbaum, JD, is the Harold and Jane Hirsh Professor of Health Law and Policy, Founding Chair of the Department of Health Policy at the Milken Institute School of Public Health, and professor of Public Policy and Public Administration, Law, and Medicine, George Washington University.
Article info
Publication history
Published online: January 09, 2018
Accepted:
October 25,
2017
Received in revised form:
October 20,
2017
Received:
January 24,
2017
Footnotes
This work was performed while Dr. Patton was a Robert Wood Johnson Clinical Scholar (VA Scholar) at the University of Michigan, Ann Arbor, Michigan. This work was performed while Dr. Sanghavi was Director of Prevention and Population Health for the Center for Medicare and Medicaid Innovation at the U.S. Department of Health and Human Services. Veronica X. Vela, Susan F. Wood, Peter Shin, and Sara Rosenbaum received funding from the Geiger Gibson fund; Elizabeth W.Patton received funding from the Robert Wood Johnson Clinical Scholars Program.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
