Provision of Immediate Long-Acting Reversible Contraceptives Before and After Wisconsin Medicaid’s Payment Change.


Objectives: To estimate the association between Medicaid unbundling of payment for long-acting reversible contraceptives (LARC) from the global delivery fee and immediate postpartum (IPP) LARC provision, in a state outside a select group of early-adopters. Results will also shed light on the potential moderating roles of hospital academic affiliation and Catholic status on the association between unbundling and IPP LARC provision. Methods: We used a pre-post design to examine the association between unbundling and IPP LARC provision. We observed Medicaid-covered childbirth deliveries in Wisconsin hospitals between January 2016-December 2017 (n=45,200) in the State Inpatient Database from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. We conducted multivariate regressions using generalized linear mixed models. Results: From 2016 to 2017, IPP LARC provision increased from 0.28% to 0.44% of deliveries (p=.003). In our adjusted model, IPP LARC provision was 1.55 times more likely in the post-period vs. the pre-period (95% CI: 1.12-2.13). Both before and after unbundling, IPP LARC provision was significantly more common in academic vs nonacademic settings and was exceedingly rare in Catholic institutions. Conclusions: In contrast to many early-adopting states, in this later-adopting state, Wisconsin Medicaid’s unbundling of LARC from the global fee did not meaningfully change rates of IPP LARC provision in the state. Results indicate that delivery hospital characteristics are strong correlates of access to IPP LARC and suggest the need for interventions—perhaps outside of the inpatient setting—to ensure that patients can access desired contraceptive methods promptly postpartum.

Women’s Health Issues