The Impact of Medicaid Reimbursement on Rates of Postpartum LARC Uptake [27J

Abstract

INTRODUCTION: There are many barriers to immediate postpartum long acting reversible contraception (LARC) placement, including lack of knowledge, restrictive placement criteria, inadequate reimbursement, and policies banning reimbursement for placement during an inpatient hospitalization. We aimed to determine the impact of a policy change by Missouri Medicaid in October of 2016 allowing reimbursement of immediate postpartum LARC placement. METHODS: We completed a retrospective cohort study comparing patients who delivered at Barnes Jewish Hospital (BJH) one year before (September, 2015-September 2016) and after (November, 2016-November, 2017) the Medicaid LARC immediate postpartum reimbursement policy change. Patients who had a contraindication to LARC placement were excluded. The primary outcome was immediate postpartum LARC placement. Demographic characteristics were compared using chi-square and Fisher’s exact test, as appropriate. Pertinent confounders were controlled for using logistic regression and the analysis was stratified by insurance type. RESULTS: A total of 6,233 women were included with 3,105 delivering before the postpartum LARC policy change and 3,128 delivering after. Immediate postpartum LARC uptake increased from 0.5% (n=16) to 7.3% (n=229) after the policy change (adjusted odds ratio (aOR) 15.4; 95% CI 9.3-25.8). In stratified analysis, postpartum LARC uptake increased in both women enrolled in Medicaid (0.7% to 9.6%; aOR 14.8; 95% CI 8.6-25.9) and private insurance (0.2% to 2.9%; aOR 13.3; 95% CI 3.2-55.9). CONCLUSION: Medicaid reimbursement for inpatient postpartum LARC is associated with an increased uptake among women with both Medicaid and private insurance. This policy change is an important step in reducing the burden of unintended pregnancies.