Contraception in Medicaid: Improving Maternal and Infant Health

The Center for Medicaid and CHIP Services (CMCS) has established a Maternal and Infant Health Initiative (the Initiative) for the Medicaid and Children’s Health Insurance Program (CHIP) programs. Under the Initiative, CMCS will promote the use of effective methods of contraception in order to improve pregnancy timing and spacing and in turn, the health outcomes for both women and children.

Medicaid & CHIP are payers of about half of all births in the U.S.

(source: Markus A. R., E. Andres, K.D. West, N. Garro, and C. Pellegrini. "Medicaid Covered Births, 2008 through 2010, in the Context of the Implementation of Health Reform.” Women’s Health Issues, vol. 23, no. 5, 2013, pp.e273-e280.)

A variety of contraceptive methods are available today such as barrier methods (condoms, diaphragms, and sponges), hormonal methods (pills, patches, rings, injectibles) and long-acting reversible contraception (LARC: intrauterine devices (IUDs) and implants). Each method has different characteristics that influence an individual’s choice; these include: effectiveness, side effects, frequency of use, and cost. In order for an individual to be able to select and use the most appropriate method for his or her circumstances, the method of choice must be both accessible and affordable.

For every dollar of public funding spent on Contraception Services, Medicaid saves $5.68 in cost associated with unintended pregnancy and infant care.

(source: Guttmacher Institute Analysis, "Contraception Needs and Services, 2010")

Improving birth outcomes is both a public health and a budgetary priority for Medicaid and CHIP. By ensuring individuals have access to the contraceptive method of their choice, and the support necessary to use their chosen method effectively, states can support not only the health of women and their children, but also reduce the number of unintended pregnancies.

Opportunities

States have a variety of tools available to address the factors that influence access to, choice of, and use of contraception. There is no single solution that addresses all of the factors that may affect a consumer. States should consider a multi-faceted approach that engages state and federal staff, the provider and stakeholder communities, and consumers.

State Plans and State Plan Amendments

States that are interested in learning more about the flexibility available under the state plan or the family planning state plan option should contact their CMS Regional Office. For more information see the State Plan Amendments (SPAs) page.

Section 1115 Demonstrations

States that are interested in section 1115 family planning demonstrations should contact the Family Planning Demonstration team at Family_Planning_Demos@cms.hhs.gov to learn more about this option. For more information see the Demonstrations & Waivers page, or learn how to apply.

Other Federal Programs

A number of federal agencies, in addition to CMS, work on issues related to improving the health and wellbeing of women and children, including on the issue of contraception. States may wish to consult with these programs when considering how to address the factors that affect contraception access and use. Examples of these programs include the Title X program overseen by the Office of Population Affairs and the Centers for Disease Control and Prevention’s (CDC) Winnable Battles, which include a focus on teen pregnancy. The CDC’s Division of Reproductive Health offers information on maternal and infant health and contraception, as does the Health Resources and Services Administration’s (HRSA’s) Maternal and Child Health Bureau (MCHB).

State Initiatives

States have significant flexibility under the Medicaid program regarding the provision of contraception, allowing states to identify ways to improve access to contraception.

For example, some states are looking at ways to alter bundled payments to support postpartum insertion of LARC for women who are interested in this option.

In 2012, the South Carolina Department of Health and Human Services (SCDHHS) updated its Medicaid payment policy to unbundle payment for delivery and for the costs associated with immediate postpartum insertion of LARC. Under this policy, providers are reimbursed specifically for both the insertion procedure and the costs of an IUD or an implant in addition to the costs of the delivery. While it is too early to quantify the impact of this policy change, it is expected to increase LARC utilization and reduce rates of mistimed and unintended pregnancy (for more information, please see Have You Heard April 2013).

Other states have taken different payment approaches to improve access to LARC in Medicaid. CMS issued an Informational Bulletin that describes emerging payment approaches that several state Medicaid agencies have used to optimize access and use of LARC. States interested in exploring the flexibilities that exist under current rules and regulations should contact their Regional Office.