Access to Women’s Reproductive Health Services in Medicaid Managed Care

Jennifer E. Moore, PhD, RN, FAAN

The Institute for Medicaid Innovation in collaboration with the Kaiser Family Foundation sought to better understand the provision of women’s reproductive health services in Medicaid with an emphasis on gleaning information about access and coverage.  Through a national survey of Medicaid managed care organization (MMCO) clinical leaders and targeted focus groups with the MMCOs, we discovered several key findings.

• Plans rely on clinics, including Federally Qualified Health Centers (FQHCs) and family planning clinics, to provide a wide range of comprehensive healthcare, including family planning services, to their members.
   
• The types of contraceptives covered by plans closely follow state policies; and some plans have policies that offer contraceptive coverage options that exceed what is available under fee-for-service programs. Plans felt that enrollees were not always aware of these options.
   
• The expense of stocking of IUDs and implants remains key challenge in ensuring access to Long Acting Reversible Contraceptives (LARC), such as IUDs and implants.
   
• Plans suggested that state payment and reimbursement methodologies that bundle pregnancy services act as a barrier to care, particularly in the provision of post-partum LARC.
   
• Frequent eligibility changes and churn among members can create a disincentive for plans to provide LARC to their enrollees.
   
• Some plans expressed concern about the issue of coercion in the promotion of LARC to Medicaid populations.
   
• Plans did not report any specific policies to assure that in-network faith-based providers with religious objections to contraception do not limit access to family planning and reproductive health services for Medicaid enrollees.
   
• Plans report that they do not measure or evaluate the quality of family planning services.

The current Administration has signaled their willingness to put more decisions about Medicaid benefits, eligibility, and financing in the hands of state policymakers. Based on proposed efforts to reform Medicaid, this will likely have implications for how MMCOs provide family planning services to their members and the types of clinics they can contract with as part of their provider network. Looking forward, the state and federal programmatic decisions will undoubtedly shape Medicaid plan choices regarding the scope of services, the network of participating providers, and the policies that Medicaid plans will use to provide low-income women with access to high quality family planning services. 

To read more about the findings, click HERE for the full report.