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Some Insurers Failing To Cover All Contraceptives; Ill. Revises Medicaid Rules To Boost Access

Some Insurers Failing To Cover All Contraceptives; Ill. Revises Medicaid Rules To Boost Access

August 22, 2014 — Some insurers that are required to cover all FDA-approved contraceptives under the Affordable Care Act (PL 111-148)are only providing coverage for a limited number of methods, Kaiser Health News reports.

Federal guidance on the contraceptive coverage rules states that insurers must cover the full range of FDA-approved methods without cost sharing. Insurers are permitted to use "reasonable medical management techniques" to curb costs, such as only covering the generic version of an approved contraceptive. In addition, some plans qualify for an exemption to the rules because they have "grandfathered" status or are for certain religious employers.

However, some women have found that health plans that are subject to the rules are not covering certain methods, KHN reports.

"[W]e've seen this happen, plenty," Adam Sonfield, senior public policy associate at the Guttmacher Institute, said. Despite guidance mandating full coverage, some "insurance companies think things are ambiguous enough that they can get away with it," he added.

Sonfield said that if a person is denied coverage, the individual should appeal the decision to his or her state insurance department. "The state has the right and responsibility to enforce this law," he said (Andrews, Kaiser Health News, 8/22).

Ill. To Increase Medicaid Reimbursement for Contraception

In related news, the Illinois Department of Healthcare and Family Services on Wednesday proposed a plan that aims to increase access to long-acting contraceptive methods by raising Medicaid provider reimbursements for contraceptive services, the Chicago Tribune/Kaiser Health News reports.

DHFS Director Julie Hamos said that the policy was spurred in part by the Supreme Court's decision in the Hobby Lobby case, which allowed some private businesses to deny contraceptive coverage in their employer-sponsored health plans. She said that while Illinois' policy change would only affect Medicaid beneficiaries, not employers, the court ruling created "an opportune time when women across the country are paying attention," which can be used "to focus on what's available to them through Medicaid."

The Illinois proposal would double provider reimbursement rates for vasectomies and intrauterine devices. The plan also would boost reimbursements for non-surgical sterilization kits and bar "step therapy" rules that require women to try certain forms of contraception before others.

Under the plan, DHFS would immediately increase the reimbursement rates for Planned Parenthood clinics and other walk-in health care providers, the Tribune/KHN reports. The changes for other providers would take effect Oct. 1.

In addition, DHFS is weighing whether it has the authority to add a new rule that would require health care providers who object to contraception to refer patients to other providers who offer the services. Federal law bars the agency from requiring providers with such objections to inform patients about contraceptives.

According to the Tribune/KHN, the department is accepting comment on the proposed policy through Sept. 15 and expects to finalize the rule later this fall (Venteicher, Chicago Tribune/Kaiser Health News, 8/21).