Medicaid Reimbursement Policies for LARC Aid Awareness, Use
Posted July 29, 2015 by Claire Rudolph and Ellen Pliska of ASTHO
|Claire Rudolph and Ellen Pliska.
Unintended pregnancies are associated with increased risk of poor maternal and infant outcomes, including delayed prenatal care, preterm birth and poor physical and mental health effects for both mother and child.1,2,3 Approximately 50 percent of pregnancies are unintended in the U.S., and, according to the American College of Obstetricians and Gynecologists (ACOG), relatively low use of long acting reversible contraceptive (LARC) methods may be partially to blame.4 Fewer than 9 percent of U.S. women were using LARC in 2009.5
LARC methods include intrauterine devices (IUD) and hormone contraceptive implants that prevent ovulation. While women can begin to use LARC at any time, ACOG has identified the immediate post-partum (IPP) timeframe as being particularly favorable due to the convenience for both patients and providers, as well as increased motivation of women to seek contraceptives. Even with this guidance, rates of LARC insertion during IPP remain low.
To help identify opportunities, challenges and technical assistance needs to improve states’ ability to promote LARCs during the important IPP timeframe, the Association of State and Territorial Health Officials (ASTHO) established a multistate LARC learning community. ASTHO, with support from the Centers for Disease Control and Prevention (CDC) and partnerships with the Centers for Medicare and Medicaid Services (CMS) and Office of Population Affairs (OPA), convened the learning community to help select states (Colorado, Georgia, Iowa, Massachusetts, New Mexico and South Carolina) establish Medicaid payment policies or pilots programs to implement IPP LARC initiatives.
Having a state Medicaid payment policy in place is beneficial in multiple ways. It facilitates provider payment for IPP LARC insertion, opens the door for increased conversation about patient and provider education and training, as well as LARC device stocking and supply—all which lead to increase access, and use, of IPP LARC.
LARC methods can cost hundreds of dollars up front.6 LARC insertion in the immediate postpartum period has traditionally been wrapped in to the maternity care payment. Therefore providers are not specifically reimbursed for IPP LARC insertion on a Medicaid-eligible woman if the state does not have a Medicaid policy for IPP LARC in place. Establishing or strengthening collaboration between the state health agency and state Medicaid agency has been a key factor in developing postpartum LARC policies. While it is too soon for states in ASTHO’s LARC Learning Community to formally report outcomes, states noted that establishing a Medicaid policy to reimburse for IPP LARC has increased their availability. (Note: the type of payment—bundled or unbundled—and the reimbursement rate vary by state.)
ASTHO and the CDC look forward to continuing LARC work in the future. Cohort Two of the learning community will be selected soon, with a second round kick-off in fall 2015. To learn more about the learning community, and to read state’s Medicaid policies, visit our website.
Claire Rudolph is the Senior Analyst for Maternal and Child Health at ASTHO. Ellen Pliska is the Family and Child Health Director at ASTHO. ASTHO is one of the partners for the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IMCoIIN) initiative.
1. Mayer JP. Unintended childbearing, maternal beliefs, and delay of prenatal care. Birth. 1997. 24(4):247–252.
2. Orr ST, et al. Unintended pregnancy and preterm birth. Paediatric Perinatal Epidemiology. 2000. 14:309–313.
3. Barber JS, Axinn WG, Thornton A. Unwanted childbearing, health, and mother-child relationships, Journal of Health and Social Behavior. 1999. 40(3):231–257.
4. “Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. ACOG Committee Opinion No. 450. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009. 114:1434-8.
5. Guttmacher Institute. Contraceptive Use in the United States. Available at: http://www.guttmacher.org/media/presskits/contraception-US/statsandfacts.html. Accessed July 24, 2015.
To learn more about NICHQ's infant health work, visit the infant health section of our website.