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Study: Medicaid Coverage for Postpartum LARC Improving

October 8, 2015 — More states are offering women the option to receive long-acting reversible contraception immediately after childbirth through Medicaid programs, according to a study in the journal Contraception, CBS News reports.

For the study, researchers with the University of Michigan Health System interviewed representatives of 40 state Medicaid agencies by phone.

Study Details

The researchers found that 19 state Medicaid programs offered reimbursements specifically for LARCs placed immediately after childbirth, up from no states providing such reimbursement three years ago. According to the study, eight more states are considering offering such reimbursements. Meanwhile, the study authors noted that many private and public insurers offer reimbursements for non-reversible contraception provided immediately postpartum.

In their interviews, the researchers found that the most frequently cited reasons that state Medicaid programs opted to cover immediate postpartum LARC included net savings, and improved maternal and child health outcomes.

Meanwhile, representatives from states that did not provide such coverage were concerned with the up-front cost of such devices and perceived health risks. However, according to medical experts, the risk of health complications stemming from immediate and delayed IUD insertion are "exceedingly low," CBS News reports (Welch, CBS News, 10/6). Meanwhile, the study noted that while LARCs can cost $600 to $775, public assistance provided for an unintended pregnancy can cost about $11,600 (Sifferlin, Time, 10/6).

Comments

The authors cited prior research that found between 40% and 60% of low-income women who say they would like LARCs do not follow up on the procedure because of barriers such as transportation and childcare.

Michelle Moniz -- study author and assistant professor of obstetrics and gynecology and researcher at the University of Michigan Medical School -- said, "Many women's first choice for birth control is an IUD or implant, which we know are the safest and most effective forms of reversible contraception." She added, "The problem is that many postpartum women can't make it back to the office for an appointment to get one. Our findings suggest that more and more agencies recognize significant benefits to providing this service before women even leave the hospital."

The study authors said they hoped more state Medicaid programs and private insurers would start provided reimbursements for LARCs placed immediately postpartum. "Reimbursement policies have been one barrier to providing a large group of high risk women with the safest and most effective forms of reversible birth control in a way that's most convenient for them," Moniz said, adding, "The majority of states ... still do not provide this specific coverage, suggesting a great need to correct misinformation about immediate postpartum contraception and concerns about cost to help promote better access for more women."

Meanwhile, Linda Bradley -- a gynecologist and vice chair of Cleveland Clinic's Obstetrics, Gynecology and Women's Health Institute -- said patient knowledge about IUDs in the U.S. "is very low." She said, "This is a gap that doctors can fill, by telling patients, this is a very safe and very effective method of contraception. These conversations about postpartum contraception should begin at the very first prenatal visit" (CBS News, 10/6).