As More States Cover Immediate Postpartum Contraception, Challenges Arise
As more states implement specific Medicaid reimbursement practices for immediate postpartum long-acting reversible contraception (LARC) such as intrauterine devices (IUDs) and implants, researchers from the University of Michigan Health System have identified challenges for agencies and providers alike in a study published in Contraception.
Michelle Moniz, MD, MSc, an assistant professor of obstetrics and gynecology and researcher at the University of Michigan Medical School, and colleagues conducted semistructured phone interviews with Medicaid representatives in 39 states, 13 of which have specific payment practices for immediate postpartum LARC devices, on agency goals for immediate postpartum LARC method reimbursement and administrative- and provider-level experiences with policy implementation.
Major themes that emerged included difficulties by the agency in promoting beneficiaries' well-being and improved access to LARC methods and provider mistrust of the agency regarding payment. Focusing on on ensuring that claims were paid and reimbursement rates sufficiently addressed clinical costs of LARC methods was also discussed in the interviews. Many expressed struggles with notifying providers effectively about inpatient method coverage and mixed reactions from providers on offering immediate postpartum LARC methods vs. concerns about potential patient harm and insufficient technical expertise. The representatives expressed concerns over limited or no resources for clinical implementation or evaluation for their primary roles as eliminating reimbursement barriers.
"Many women's first choice for birth control is an 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,” said Dr. Moniz. “Our findings suggest that more and more agencies recognize significant benefits to providing this service before women even leave the hospital." The authors are optimistic that as more Medicaid programs cover immediate postpartum LARC methods for timely contraception, opportunities will emerge for discussing these and other barriers. Eight additional states are currently considering immediate postpartum LARC insertion reimbursement.
For more information visit med.UMICH.edu.