Delaware and Georgia Use Innovative Strategies to Promote Women’s Health in Medicaid

Posted April 11, 2017 by Liz McCaman

Liz McCaman
Liz McCaman

NASHP and NICHQ release case studies on Delaware and Georgia’s uses of Medicaid policy to help reduce costly unplanned births. The experiences of these two states highlight the diversity of innovative approaches to increasing access to preventive services. These case studies supplement the previously released issue brief “Strategies to Increase Access to Long-Acting Reversible Contraception (LARC) in Medicaid.”

Unplanned pregnancies present a challenge for many women, their families and communities, and are associated with a number of costly health outcomes, including delayed prenatal care, premature birth and low birth weight. Federal initiatives like the Collaborative Improvement & Innovation Network to Reduce Infant Mortality (IM CoIIN) have helped to engage state leaders in efforts to reduce infant mortality rates, eliminate disparities in birth outcomes and improve systems to lead to healthier births.

Both Delaware and Georgia are members of the IM CoIIN, actively working to improve birth outcomes statewide. These states have recently implemented innovative Medicaid payment strategies to help reduce costly unplanned births and promote women’s health by increasing access to long-acting reversible contraception (LARC). Both have updated their payment models to allow for LARC insertion in the inpatient setting after childbirth.

Delaware has partnered with Upstream USA, a non-profit organization that provides on-site training and technical assistance for same-day LARC insertion to health centers nationwide, to increase provider capacity for the procedure. The state has also developed an intra-agency workgroup to guide its initiative, bringing together representatives from Delaware’s Medicaid agency, public health agency, community stakeholders and political leadership. 

Click here to read NASHP and NICHQ’s previous issue brief on LARC access, as well as the case studies on Delaware and Georgia. 

In Georgia, federally qualified health centers (FQHCs) can obtain discounted prices on LARC through the federal 340B Drug Pricing Program—a federal program that enables hospitals and other clinics that receive federal safety-net funding to purchase outpatient drugs at a ceiling price calculated by the Health Resources and Services Administration. Under the authority of a State Plan Amendment, Georgia FQHCs can purchase LARC from the manufacturer at the discounted price from the 340 program. FQHCs then receive Medicaid reimbursement once LARC is dispensed to an eligible patient.

Because of the modified Medicaid policies, private payers in both states have begun to follow suit; commercial insurers are providing increased incentives for healthcare professionals to offer LARC to their patients. As more healthcare professionals consider offering LARC, states are seeing an increased demand for high-quality education on LARC placement, reimbursement, monitoring and removal.

Through their participation in IM CoIIN, Delaware and Georgia leveraged partnerships and created strategies to address unplanned pregnancies, a large driver of infant and maternal mortality. Additional states and stakeholders in infant health can consider these specific programs as models for increasing LARC access, and can also emulate Delaware and Georgia’s high levels of collaboration and engagement for affecting systemic changes. 


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