Abstract
OBJECTIVES: Medicaid reimbursement for long-acting reversible contraceptives provisioned immediately postpartum (IPP-LARC) has historically been included as part of the diagnosis-related group (DRG) fee for delivery. To rectify this financial disincentive, policies to reimburse hospitals for IPP-LARC, supplemental to the DRG fee, were implemented. This review synthesizes the impact of these policies. STUDY DESIGN: Systematic literature review. METHODS: A search in Medline, EMBASE, and CINAHL was executed on November 21, 2022. Impacts on uptake of IPP-LARC, short-interval pregnancy, and author conclusions were synthesized. RESULTS: Twenty studies reporting on Medicaid reimbursement policies across 15 states were included. The average age of women across study populations ranged from 22.2 to 31.0 years; populations were racially, and ethnically diverse; primarily urban hospitals were included. Sixteen studies reported on uptake and 7 studies reported on birth outcomes. Statistically significant increases in uptake after policy implementation were reported in 9 studies across Delaware, Georgia, New York, Rhode Island, Wisconsin, Washington, Louisiana, Missouri, and South Carolina. Policy implementation in South Carolina and Ohio resulted in significantly lower rates of short-interval pregnancy, as reported in 6 studies. Smaller, rural, and religiously affiliated hospitals were significantly less likely to leverage Medicaid policies for IPP-LARC. Key determinants of increased uptake were provider champion advocacy, co-interventions for training hospital staff, and relieving the up-front financial burden associated with stocking LARCs. CONCLUSIONS: Medicaid reimbursement policies targeting IPP-LARC access are associated with increased adoption and reduced short-interval pregnancy. Co-interventions supporting hospitals and individuals who are immediately postpartum would further facilitate IPP-LARC access.