title: Medicaid Administrator Experiences with the Implementation of Immediate Postpartum Long-Acting Reversible Contraception.
abstract: This study sought to understand state Medicaid agencies' experiences with implementing payment for long-acting reversible contraception devices inserted immediately postpartum.
  
  
  
  We conducted semistructured telephone interviews with Medicaid representatives from 15 agencies that have specific payment methodology for immediate postpartum long-acting reversible contraception (IPLARC). Interviews investigated agency experiences with IPLARC policy implementation. Interviews were audio-recorded and professionally transcribed. We analyzed data thematically using qualitative content analysis principles.
  
  
  
  Described implementation experiences fell into three major categories: 1) payer preparedness regarding payment challenges, 2) health care system awareness, attitudes, and readiness to implement IPLARC policy in clinical settings, and 3) ongoing practice improvement. Within the category of payer preparedness, major emergent themes included Medicaid's need to ensure efficient claims processing, maintain appropriate reimbursement rates, and alleviate perceived provider mistrust about payment. With respect to health care systems, themes emerged around raising clinician awareness of IPLARC coverage, managing provider misconceptions about IPLARC, and addressing gaps in provider IPLARC insertion expertise. Regarding practice improvement, a salient theme emerged around the limitations of Medicaid to engage in ongoing clinical implementation and evaluation efforts.
  
  
  
  These findings suggest a multistakeholder implementation framework that can guide the growing number of Medicaid agencies newly implementing IPLARC policy. As more Medicaid programs remove reimbursement barriers to IPLARC, clinicians and hospital administrators have a crucial opportunity to address clinical barriers to IPLARC and ensure real-time access among beneficiaries who desire this safe and effective approach to contraception.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan. Electronic address: mmoniz@med.umich.edu.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Moniz
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chang
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan; Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Landgraf
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
mesh_terms: D000067575:Administrative Claims, Healthcare; D003267:Contraception / Q000191:economics / Q000379:methods*; D004343:Drug Implants; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007407:Interviews as Topic; D008484:Medicaid / Q000191:economics* / Q000458:organization & administration; D049590:Postpartum Period; D011247:Pregnancy; D016730:Program Development / Q000379:methods*; D036301:Qualitative Research; D012051:Reimbursement Mechanisms; D013219:State Government; D014481:United States
chemical_list: D004343:Drug Implants