Rethinking reimbursement: new research on how to improve birth control access

Expanding access to comprehensive, appropriate, effective contraceptive care is critical to helping ensure people across the country are in full control of their health and can build the futures they dream of. Contraceptive choice and access are fundamental components of comprehensive health care and access to the full range of contraceptive methods correlates with positive outcomes for women in education, participation in the workforce, earning power, and happiness.

Nationwide, millions of women utilize Federally Qualified Health Centers (FQHCs) to access reproductive care. However, methods like IUDs and implants (long-acting reversible contraceptives, or LARCs) can be more costly for FQHCs to stock and provide necessary care for. In many states, this means LARCs are so expensive for FQHCs that they can’t offer them to their patients – even when it’s the best option based on a patient’s choice and needs.

In a new policy brief published today in partnership with Medicines 360 and Health Management Associates (HMA), our Health Practice discusses how changes to state Medicaid reimbursement policies would help make LARCs more accessible.

Typically, FQHC’s are reimbursed at a rate that averages the cost of all the care that a patient might receive in a visit.  While these “bundled” rates may be appropriate reimbursement for many services, they often are insufficient to cover LARC devices and necessary associated services like counseling, insertion, and removal. This limits the ability of many FQHCs to reliably stock and provide LARCs to patients who want them. Allowing states to reimburse for LARC devices separately (or “unbundling”) from other care helps FQHCs make options like IUDs and implants available for patients who choose them.

Multiple states have already successfully used unbundling to increase access to LARCs. Our partners at HMA discuss Georgia Medicaid’s experience with implementing the policy in more depth in the accompanying “Case Study of Georgia Medicaid’s Experience,also released today. The insights in that case study contribute to the core finding of our policy brief: policymakers at the state level should look to one of two processes to change reimbursement policy and “unbundle” LARC device reimbursement.

Commenting on this work, Waxman Strategies’ Senior Director Zara Day shared:

“Increasing access to contraceptives is a vital part of protecting autonomy and supporting people in making the choices that are best for themselves and their families. We are proud to partner with Medicines360 and others to work towards equitable access to services and products that allow people to be in full control of their bodies and their lives.”

Our policy brief explores two possible solutions; pursue a Medicaid State Plan Amendment (SPA) to allow separate reimbursement for LARCs, or implement an FQHC Alternate Payment Methodology (APM) that better incorporates the costs of LARCs into payment rates. Broadening contraceptive access and choice has vital ripple effects across people’s entire lives – it is critical to improving public health and economic mobility. We strongly encourage states and providers interested in expanding people’s access to the full range of contraceptives to consider this framework.

Led by Chairman Waxman, Waxman Strategies is committed to expanding his legacy of improving access to affordable reproductive health care for all patients. This policy brief is a part of our larger efforts to identify the causes of, and propose solutions to, inequitable availability of contraceptives. As debates continue in statehouses across the country over how to address these issues, we encourage policymakers to consider the role that reimbursement could play.

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