Variation Among State Medicaid Policies Regarding Coverage of Long Acting Reversible Contraception [7O

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INTRODUCTION: Data demonstrates the benefits of Long Acting Reversible Contraceptives (LARC) to reduce unintended pregnancy. In 2014, the Centers for Disease Control and the U.S. Office of Population Affairs issued guidelines for Quality Family Planning services that emphasized a client centered approach to help individuals make informed decisions about contraception use while providing timely access to their chosen method. We sought to understand whether current State Medicaid policies supported timely access to the most effective methods for reducing unintended pregnancy. METHODS: The study reviewed Medicaid LARC policies for a purposive sample of states including California, New York, Texas, Illinois, Pennsylvania, Georgia, Colorado, Missouri and the District of Columbia. We completed a content analysis of policy documents and semi-structured interviews of key state Medicaid officials. RESULTS: The results identified three key areas of policy variation: eligibility, payment mechanisms and delivery systems. State political climates and interaction with other Federal programs, including Title X and 340B drug pricing program add complexity to states' ability to pay and deliver LARC to women. Specific policies such as the promotion of postpartum LARC insertion have been embraced by most states (8 of 9 sampled). Other policy innovations such as pharmacy stocking have been pursued less frequently (2 of 9 states). CONCLUSION: Current Medicaid LARC policies are heterogeneous and complex, which may hinder development of effective promotion and use of LARC as first line contraceptives for women who desire them. Policy makers should focus on eligibility, payment mechanisms and well-coordinated delivery systems to achieve optimal family planning care.