National Partnership for Women & Families

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Texas changing Medicaid policy to reimburse for postpartum LARC

Texas, along with several other states, is revising its Medicaid reimbursement policy to cover the provision of long-acting reversible contraception (LARC) immediately after delivery, Kaiser Health News/Texas Tribune reports (Luthra, Texas Tribune/Kaiser Health News, 10/18).

Medicaid LARC coverage

LARC, including intrauterine devices (IUD) and hormonal implants, are seen as ways to reduce the country's rate of unintended pregnancies and associated costs. LARC devices are more effective than other forms of contraception and can last between three and 10 years after insertion.

State Medicaid programs are required to cover family planning services at no out-of-pocket cost (Women's Health Policy Report, 6/16). In the past, most state Medicaid programs did not include the option for IUDs in the payment set for labor and delivery.

However, the Centers for Disease Control and Prevention has identified the provision of LARC immediately post-partum as key to reducing unintended pregnancy, and the Centers for Medicare and Medicaid Services this spring urged states to cover the procedure. The American College of Obstetricians and Gynecologists and the Association for State and Territorial Health Officers have also supported the practice.

Twenty states as well as Washington, D.C. are promoting the practices, and others are considering it, according to KHN/Tribune.

New reimbursement policies

Texas is one of the states revising its Medicaid payment policy to cover the provision of LARC post-delivery.

In the past, doctors often waited until a woman returned for her postnatal visit -- about six weeks after delivery -- to discuss LARC, but research shows that between 10 and 40 percent of women do not make it to the postnatal visit. In Travis County, Texas, Ted Held, director of reproductive health at People's Community Clinic, said the figure is closer to 60 percent for women on Medicaid.

KHN/Tribune reports implementing the policy requires buy-in from local governments, hospitals and individual providers. Challenges to implementation include a lack of providers trained in the procedure or in LARC counseling, resistance from Catholic hospitals, financial costs associated with maintaining a stock of LARC -- particularly in rural areas -- and barriers to providing LARC counseling to women prior to delivery because of a lack of appropriate prenatal care, according to KHN/Tribune. Follow-up care can also pose an obstacle as many women are no longer eligible for Medicaid after their pregnancy, meaning they could have difficulties getting LARC removed or addressing any potential complications.

To help with provider training, Texas has developed a toolkit that hospitals can use to teach staff about providing LARC. On a nationwide scale, ACOG is dispatching doctors to help with training.

According to KHN/Tribune, other states have seen the provision of LARC increase after changing their Medicaid policies to reimburse for the procedure. For instance, South Carolina, which changed its policy in 2012, saw IUD and implant insertions more than double between fiscal years 2013 and 2015, according to data monitored by the state health officers' association. In Colorado, the state government recovered its investment in its IUD program more than six times over. In addition, there were 271 LARC insertions in Delaware between March 2015, when it stared reimbursing for the procedure, and August 2016.

Held said research indicates there will be similar demand in Texas. "We want to make sure that access is broad -- and that all women have access to this," Held said (Texas Tribune/Kaiser Health News, 10/18).