Medicaid Coverage of Family Planning Benefits: Results from a State Survey
Executive Summary
Food and Drug Administration (FDA), Approved methods of contraception for women.
Gavin, L., et al. Providing Quality Family Planning Services, MMWR, April 25, 2014.
Introduction
Kaiser Family Foundation; Status of State Action on the Medicaid Expansion Decision; As of January 12, 2016; Since July 1, 2015 Alaska implemented a Medicaid expansion (9/1/2015) as did Montana (1/1/2016) and Louisiana’s (7/1/2016).
Guttmacher Institute, Medicaid Family Planning Eligibility Expansions, State Policies in Brief, as of October 1, 2015.
Gold, RB. “Doing More for Less: Study Says State Medicaid Family Planning Expansions Are Cost-Effective.” Guttmacher Report on Public Policy, March 2004.
Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision.
Kaiser Family Foundation. Women and Health Insurance, November 2013
Reversible Contraception
Cooper, C., et al. Interpregnancy Intervals in the United States: Data From the Birth Certificate and the National Survey of Family Growth, National Vital Statistics Reports, April 16, 2015.
All Patient Refined Diagnosis Related Group. Currently three major versions of the DRG in use include: basic DRGs, All Patient DRGs, and All Patient Refined DRGs. DRGs, used by Medicare, measure the typical resource use of an inpatient stay. AP-DRGs are similar to DRGs, but also include a more detailed DRG breakdown for non-Medicare patients such as newborns and children. The APR-DRG structure is similar to AP-DRG, but also measures severity of illness and risk of mortality in addition to resource utilization. See: Jason Shafrin; What is the Difference Between DRGs, AP-DRGs and APR-DRGs; Healthcare Economist; June 2012; accessed at: http://healthcare-economist.com/2012/06/19/what-is-the-difference-between-drgs-ap-drgs-and-apr-drgs/
This survey was conducted prior to California’s implementation of policy requiring Medicaid plans to cover 12 month supply of oral contraceptives.
Plan B, progestin, brand names include Plan B One Step, Next Choice One Dose, My Way and Take Action.
In Indiana, contraceptive drugs and supplies may be administered, dispensed, prescribed, or ordered. However, for a pharmacy provider to be reimbursed for over-the counter external contraceptive supplies, a Medicaid practitioner with prescriptive authority must prescribe them. IHCP Bulletin BT201301; January 8, 2013 accessed at: http://provider.indianamedicaid.com/ihcp/Bulletins/BT201301.pdf.
Sterilization Procedures
42 CFR §441.250 through 441.259
Managed Care and Family Planning Services
Kaiser Family Foundation, Medicaid’s Role for Family Planning, July 2015.
One of the five states reporting that it does not claim the 90 percent FMAP (Idaho) contracts with only one MCO to provide services in the state’s Medicare Medicaid Coordinated Plan (MMCP), a type of Fully Integrated Dual Eligible Special Needs Plan that enrolls individuals over the age of 21 that are eligible for both Medicare and Medicaid. For a description of the MMCP, see: http://healthandwelfare.idaho.gov/Medical/Medicaid/MedicaidParticipants/MedicareMedicaidCoordinatedPlan/tabid/2538/Default.aspx.
Conclusion
Yarnall, et al. Primary Care: Is there Enough Time for Prevention?, AJPH, 2002.
ACOG Committee on Obstetric Practice (2016). Immediate Postpartum Long Acting Reversible Contraception.
Centers for Medicare and Medicaid Services (2016). State Medicaid Payment Approaches to Improve Access to Long-Acting Reversible Contraception.
Moniz, M., et al. Medicaid Administrator Experiences with the Implementation of Immediate Postpartum Long-Acting Reversible Contraception, Women’s Health Issues, May-June 2016.
Gavin, L., et al. Providing Quality Family Planning Services, MMWR, April 25, 2014.