State Medicaid Programs’ Coverage for Long-Acting Reversible Contraception is Uneven, Study Finds

State Medicaid programs must cover family planning services, but wide variation in specific policies around payment and training means low-income women's access to some of the most effective methods of contraception can vary by state. Researchers who analyzed nine states' Medicaid policies around long-acting reversible contraceptives (LARC) found most did not explicitly cover all key elements of quality contraceptive care. They report their findings in a study published in Women's Health Issues, "Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception."

The co-first authors of this study are Veronica Vela, a doctoral student at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University, and Elizabeth Patton, who conducted the research while a Robert Wood Johnson Clinical Scholar at the University of Michigan and is currently an assistant professor at the Boston University School of Medicine. Other Milken Institute SPH authors include Susan F. Wood, PhD, Peter Shin, PhD, and Sara Rosenbaum, JD. Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute SPH.

To examine variations in Medicaid LARC coverage, Vela, Patton, and their colleagues selected nine states that varied by geography, whether they had accepted the Affordable Care Act's Medicaid expansion, and the number of women of childbearing age covered by Medicaid: California, Colorado, Georgia, Illinois, Missouri, New York, Pennsylvania, Texas, and the District of Columbia (DC is treated as a state here because it runs its own Medicaid program as the fifty states do). They focused on LARC methods – intrauterine devices (IUDs) and contraceptive implants – because they are the most effective reversible methods of contraception and because their high upfront costs make insurance coverage especially important. In analyzing policies, they considered key elements of quality contraceptive care outlined in CDC’s “Providing quality family planning services” guide: coverage of a full range of contraceptive services and supplies (including LARC methods), counseling on methods, removal of devices, and follow-up care as needed. 

The analysis found that several states did not explicitly cover contraceptive counseling, which Vela, Patton, and their co-authors note can dis-incentivize the delivery of high-quality counseling on the range of contraceptive options. They also report that several states do not specify coverage for removal of LARC devices or follow-up care, although such coverage “is not only clinically but also ethically appropriate, so that patients may discontinue a method if not satisfied or if they desire to become pregnant.” 

The study also highlights innovations in payment policies in California, Illinois, New York, and Texas that reduce some of the common barriers to LARC access, and notes that some states sponsor LARC training for providers. Ensuring that Medicaid plans “address all elements of quality family planning care, including access to the full range of LARC methods, can promote equity across plans,” the authors conclude.

"Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception" has been published in the March/April issue of Women’s Health Issues.