Ore. Medicaid program mulls covering LARC placement immediately postpartum

July 26, 2016 — Officials with Oregon's Medicaid program are considering a policy that would reimburse providers for administering long-acting reversible contraception (LARC) immediately after a woman gives birth or has an abortion, the Bend Bulletin reports.

According to the Bulletin, Oregon's Health Evidence Review Commission (HERC) proposed the state's Medicaid program, Oregon Health Plan (OHP), adopt the new LARC reimbursement policy. HERC, which regulates what OHP includes in its coverage, could approve the policy change as soon as October.


OHP currently provides coverage for LARC, including intrauterine devices (IUDs) and implants. However, the state provides reimbursement for LARC separately from reimbursement for delivery services, which means that many providers do not administer LARC until a woman visits for follow-up care. A woman may become pregnant again in the weeks before a follow-up visit, or she might not be able to make the follow-up appointment, the Bulletin reports.

Catherine Livingston, associate medical director of HERC, expressed concern about the delay before follow-up care, noting that a woman might not be able to get to a follow-up appointment because of a lack of money, insurance coverage, transportation or childcare, among other factors.

Officials recommend policy change

In draft guidance, HERC recommended OHP include coverage for LARC immediately postpartum.

HERC cited research showing that immediate LARC placement lowers overall costs by helping reduce the rate of unintended pregnancy. In addition, another study found that women who had an IUD placed immediately postpartum had higher rates of IUD use six months post-insertion than women who had an IUD placed after a delay. The higher rates remained even after accounting for a slightly higher rate of IUD expulsion among women who had the device placed immediately postpartum.

Livingston said while the state has not determined how it would implement the reimbursement policy if it decides to go ahead with the policy change, state officials likely would implement postpartum LARC reimbursement separately from delivery reimbursement.

According to Livingston, state officials began considering the policy change before CMS issued a notice in April advising states to adopt such reimbursement policies. The Bulletin reports that 19 states currently have Medicaid policies in place that reimburse for LARC placement immediately postpartum.


In comments expressing support for the policy change, some providers in the state called for similar coverage in Citizen Alien Waived Emergent Medical (CAWEM), the state's health care program for low-income, undocumented immigrants who have a medical emergency, such as a pregnancy. According to the Bulletin, the CAWEM coverage ends before a woman would return for follow-up care after a delivery.

Holly Pranaat, a certified nurse-midwife with Providence Columbia Women's Clinic, wrote in an email to HERC, "Many of the CAWEM patients that I serve are recent immigrants who are fleeing violence and seeking a better life for their families ... Family planning is a vital aspect of this as women strive to provide for their children and work out of poverty."

Livingston said HERC is exploring the matter.

Separately, in an email to OHP officials, Olivia Kroening-Roche -- a nurse-midwife at Women's Healthcare Associates, a facility in Tualatin, Oregon -- expressed support for the proposed policy change, stating, "It is hard to imagine why this would not be enacted" (Bannow, Bend Bulletin, 7/21).