title: Characterization of Medicaid policy for immediate postpartum contraception.
abstract: OBJECTIVE
  Long-acting reversible contraception (LARC) is safe, effective and cost-saving when provided immediately postpartum but currently underutilized due to nonreimbursement by Medicaid and other insurers. The objectives of this study were to (a) determine which state Medicaid agencies provide specific reimbursement for immediate postpartum LARC and (b) identify modifiable policy-level barriers and facilitators of immediate postpartum LARC access.
  
  
  METHODS
  We conducted semistructured telephone interviews with representatives of 40 Medicaid agencies to characterize payment methodology for immediate postpartum LARC. We coded transcripts using grounded theory and content analysis principles.
  
  
  RESULTS
  Three categories of immediate postpartum LARC payment methodology emerged: state Medicaid agency (a) provides separate or increased bundled payment (n=15), (b) is considering providing enhanced payment (n=9) or (c) is not considering enhanced payment (n=16). Two major themes emerged related to Medicaid decision-making about immediate postpartum LARC coverage: (a) Health effects: States with payment for immediate postpartum LARC frequently cited improved maternal/child health outcomes as motivating their reimbursements. Conversely, states without payment expressed misinformation about LARC's clinical effects and lack of advocacy from local providers about clinical need for this service. (b) Financial implications: States providing payment emphasized overall cost savings. Conversely, states without reimbursement expressed concern about immediate budget constraints and potential adverse impact on existing global payment methodology for inpatient care.
  
  
  CONCLUSIONS
  Many states have recently provided Medicaid coverage of immediate postpartum LARC, and several other states are considering such coverage. Addressing misinformation about clinical effects and concerns about cost-effectiveness of immediate postpartum LARC may promote adoption of immediate postpartum LARC reimbursement in Medicaid agencies currently without it.
  
  
  CONCLUSIONS
  Medicaid policy for reimbursement of immediate postpartum LARC is evolving rapidly across the US. Our findings suggest several concrete strategies to remove policy-level barriers and promote facilitators of immediate postpartum LARC.
authors.affiliation: Department of Obstetrics and Gynecology, Ann Arbor, MI, USA; Robert Wood Johnson Foundation Clinical Scholars®, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA. Electronic address: mmoniz@med.umich.edu.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Moniz
authors.affiliation: Department of Obstetrics and Gynecology, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars®, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA; Department of Internal Medicine, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, Ann Arbor, MI, USA; Department of Health Management and Policy, School of Public Health, Ann Arbor, MI, USA; Gerald R. Ford School of Public Policy, Ann Arbor, MI, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars®, Ann Arbor, MI, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Iott
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars®, Ann Arbor, MI, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Landgraf
authors.affiliation: Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA; Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chang
mesh_terms: D003267:Contraception / Q000191:economics* / Q000379:methods; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007342:Insurance Benefits / Q000191:economics / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence*; D049590:Postpartum Period; D011247:Pregnancy; D013219:State Government; D014481:United States
keywords: Immediate postpartum contraception; LARC; Long-acting reversible contraception; Medicaid; Reimbursement