Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception |
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Authors: | Veronica X. Vela Elizabeth W. Patton Darshak Sanghavi Susan F. Wood Peter Shin Sara Rosenbaum |
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Affiliation: | 1. Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC;2. Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts;3. OptumLabs, Cambridge, Massachusetts;4. Jacobs Institute of Women''s Health, Milken Institute School of Public Health, George Washington University, Washington, DC;5. Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC;6. Center for Health Policy Research, Milken Institute School of Public Health, George Washington University, Washington, DC |
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Abstract: | ContextLong-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.MethodsUsing 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.ResultsAll 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.ConclusionsAlthough 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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Keywords: | Correspondence to: Veronica X. Vela, MS, IEOR, DrPH(C), George Washington University, Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, 2175 K Street NW, 5th Floor, Washington, DC 20037. Phone: +(202) 594-6394 fax: +(202) 994-3500. |
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