Hospital Reimbursement Boosts Access to Birth Control Postpartum

A new study recently published in JAMA Network Open indicates that hospital reimbursement for immediate postpartum long-acting reversible contraception (LARC) leads to greater access to birth control when a patient has just had a baby.

Accessing birth control is a major care gap for postpartum patients. Many birthing people must wait until their six-week follow-up appointment after giving birth to discuss birth control options with their doctors. Additionally, if patients attend that appointment and choose a LARC option, such as a contraceptive implant or intrauterine device (IUD), then they must undergo another procedure.

Researchers pointed out that “[i]mmediate postpartum LARC is an important option for postpartum people given well-documented gaps in postpartum care access and insurance coverage in the US, as well as the acceptability, safety, and effectiveness of LARC.”

However, hospital reimbursement may have hindered access to LARC while a patient recovers from childbirth in the hospital, they said.

Medicaid specifically did not include LARC provision as part of its fixed global payment to hospitals prior to 2012. The program, which pays for about 42 percent of childbirth hospitalizations each year, reimbursed hospitals separately for implants and IUDs.

By 2018, more than half of state Medicaid programs have developed policies to reimburse hospitals for immediate postpartum LARC. In five early-adopting states (Georgia, Iowa, Maryland, New York, and Rhode Island), the reimbursement policy was associated with greater access to immediate postpartum LARC.

Specifically, researchers found that, among Medicaid-paid births, the quarterly trend in immediate postpartum LARC provision increased after hospital reimbursement by 0.14 percentage points (in Georgia, 0.05 percentage points in Iowa, 0.05 percentage points in Maryland, 0.17 percentage points in New York, and 0.82 percentage points in Rhode Island.

Even greater increases were observed in the final quarter of the study period, with the policy being associated with increases of  1.88 percentage points in Georgia, 0.38 percentage points in Maryland, 2.27 percentage points in New York, and 9.15 percentage points in Rhode Island. This trend was not observed in Iowa.

Medicaid policies involving hospital reimbursement for immediate postpartum LARC provision were also linked to an increase among commercially-paid childbirth hospitalizations within four of the five early-adopting states. Although the effect was slight compared to the Medicaid-paid births, researchers said.

Medicaid hospital reimbursement is a step forward for postpartum care access. However, researchers stated that it is just one piece of the puzzle for postpartum patients.

The study found that the provision of immediate postpartum LARC was concentrated among a small group of hospitals. These hospitals were disproportionately urban, teaching hospitals equipped to provide the highest level of obstetric care, and were less likely to be owned by or affiliated with a Catholic organization. The study also showed a wide range of effect sizes between states despite overall increases.

The findings suggest that more training and financial support, especially for smaller rural hospitals, could boost access to immediate postpartum birth control even more.