October 27, 2022 – The use of long-acting reversible contraception (LARC)—such as intrauterine devices (IUDs) or contraceptive implants—increased among people who recently gave birth in states that switched their Medicaid policies to include hospital reimbursement for such contraception, according to a study from Harvard T.H. Chan School of Public Health.
The study, published October 21 in JAMA Network Open, was co-authored by Jessica Cohen, Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Associate Professor of Global Health.
Immediate postpartum LARC is considered an important option given gaps in postpartum care access and insurance coverage. Prior to 2012, Medicaid offered fixed payments to hospitals for childbirth care, whether or not the hospitals provided LARC, which likely hampered many hospitals’ ability to offer these methods because they can be costly. Currently, Medicaid programs in more than half of states have changed their policies to separately reimburse for immediate postpartum LARC.
For the study, researchers analyzed the use of immediate postpartum LARC in five states—Georgia, Iowa, Maryland, New York, and Rhode Island—all of which switched their Medicaid policies, between March 2014 and January 2015, to include separate reimbursements for LARC. Among Medicaid-paid births, the policy change was linked with a significant increase in the use of LARC, according to the study. In addition, the policy was also associated with an increase in LARC among commercially-paid births in four out of five states.
The increases in the use of LARC were more likely to occur in urban teaching hospitals providing the highest level of obstetric care, and less likely to occur in Catholic or rural hospitals, the study found.
An article by the NIHCM Foundation, which provided funding for the study, highlighted the importance of providing Medicaid coverage for immediate postpartum LARC, noting that it “may reduce adverse maternal and child health outcomes associated with short-interval pregnancies that occur within the first six months post-childbirth and are largely unplanned.”
Read an NIHCM Foundation article: Does Medicaid Reimbursement Impact Immediate Postpartutm Long-Acting Reversible Contraceptive Use?
Reducing short-interval births in South Carolina (Harvard Chan School News)