Long-Acting Reversible Contraception in Medicaid: Where Do We Go From Here?

Fuerst, Megan; George, Karen; Moore, Jennifer E.

doi:10.1016/j.whi.2020.11.010

Cited by 7 publications

(2 citation statements)

References 22 publications

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“…Similar payment mandates were not issued for the privately insured. Hospitals obtained clinical and business operations training which was meant to address the billing and coding challenges that have been encountered in other states implementing IPP payment reform (Fuerst et al, 2021 ; Lacy et al, 2020 ). The largest delivery hospital in the state, responsible for approximately 50% of deliveries, had a strong champion provider and began offering IPP LARC services in 2015, while other hospitals joined on a rolling basis between 2016 and 2018.…”

Section: Methodsmentioning

confidence: 99%

“…Given the wide variation in experiences with IPP payment reforms, it is key to identify circumstances under which these interventions can be successful. Previous studies have underscored the importance of providing training for healthcare providers and technical assistance to support the implementation of payment reforms (Fuerst et al, 2021 ; Lacy et al, 2020 ; Okoroh et al, 2018 ). And state-wide comprehensive family planning interventions encompassing information campaigns, no-cost contraceptive services, and/or provider training have been found to reduce barriers to contraceptive access among women of reproductive age (Biggs et al, 2015 ; Birgisson et al, 2015 ; Boudreaux et al, 2020 ; Lindo & Packham, 2017 ; Ricketts et al, 2014 ; Secura et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

Caudillo

Hurtado-Acuna

Rendall

et al. 2022

Matern Child Health J

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Objectives Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. Methods We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment. Results Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046). Conclusions for Practice The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

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Section: Methodsmentioning

confidence: 99%