Examining the Association of Immediate Postpartum Long-Acting Reversible Contraception Payment Carve-outs and Postpartum LARC Use in Medicaid [A04

Abstract

INTRODUCTION: Providing contraception in the postpartum period is essential to prevent unintended pregnancies and optimize birth spacing. The Medicaid program funds the majority of public family planning expenditures and pays for half of births in the United States. To improve postpartum contraception use, Medicaid stakeholders have focused on long-acting reversible contraception (LARC), which includes intrauterine devices and the contraceptive implants. A key platform for improving postpartum LARC access has been the adoption of carve-out policies that increase reimbursement for immediate postpartum LARC (IPP-LARC) services outside of the standard global maternity payment provided by Medicaid. IPP-LARC is LARC insertion that occurs after childbirth but prior to hospital discharge. IPP-LARC carve-out policies may increase postpartum LARC use among Medicaid enrolled individuals. METHODS: This study used the U.S. Centers for Disease Control Prevention Pregnancy Risk Assessment and Monitoring System dataset from 2016-2018 to explore the association between IPP-LARC carve-out policies and the use of postpartum LARC versus another form of hormonal and/or nonhormonal contraception. The study was approved by the institutional review board (IRB) at George Washington University. RESULTS: The study included 24,807 Medicaid enrolled postpartum individuals from 26 states. Results suggest that IPP-LARC policies are positively associated with LARC use over other forms of contraception and state Medicaid expansion status and postpartum visit attendance modify the association. CONCLUSION: The findings support the growing body of evidence that IPP-LARC carve-out policies and Medicaid expansion positively influence postpartum LARC use. Widespread adoption and implementation of such policies may be a key strategy to improve postpartum contraception access for Medicaid enrollees.