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Medicaid Managed Care and the Provision of Family Planning Services

Managed care organizations that coordinate members’ health care to improve the quality of services provided and reduce unnecessary costs have become the primary care arrangement for women on Medicaid. Family planning has long been a mandated benefit under Medicaid and holds important protections such as freedom of choice of provider, an enhanced federal match, and a ban on cost sharing. However, the variability among state Medicaid policies at both the state and plan level leaves room for inconsistent coverage and access to family planning services and providers for MCO members seeking contraceptive care.

Health plans expressed that MCOs are adept at care coordination, including face-to-face visits, targeted education, and the regular review of claims to address reimbursement problems. These plans also identified several areas where there are barriers in how family planning services are billed and reimbursed, particularly post-partum LARC, as well as the way they are measured for purposes of quality reporting. In addition, the frequency of churn for low-income women presents a financial disincentive for plans to provide comprehensive, long-term contraceptive care. Religious institutions and providers may also serve as an obstacle in the path of women seeking family planning services. Plan members may not be aware of the religious restrictions their health care providers place on their family planning care, and it is left to enrollees to seek help from their plan to find those services elsewhere.

Health plans also identified policies they believed would help to overcome the barriers to quality family planning services and supplies in the Medicaid managed care system. They emphasized the need for state Medicaid programs to unbundle payments for pregnancy care, and in particular, to reimburse post-partum LARC devices and insertions separately in order to more effectively promote their use post-partum. Innovative policies to aid providers in the stocking of IUDs and implants are also essential to the timely provision of the full-range of contraceptive care. Furthermore, this study has highlighted the lack of data collected on the provision of family planning services to Medicaid populations in order to measure and evaluate quality and access in the managed care setting, in most cases because of the lack of valid and reliable measures. This may change with the new family planning quality measures recently endorsed by the National Quality Forum.

This survey sought to understand better how Medicaid MCOs are providing family planning services to their members. We sought to understand the challenges that plans have identified as well as uncover innovative strategies used to address them. As federal and state policymakers explore opportunities to restructure the Medicaid program, consider changes to benefits and eligibility, and potentially reduce the pool of available family planning providers such as Planned Parenthood®, Medicaid MCOs will likely have a growing role and greater responsibility to assure that their members have access to the full range of high quality family planning services.

Report

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.