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Most State Medicaid Programs Cover Prescription Contraceptives, While Coverage of Over-the-Counter Contraceptives Varies

A new Kaiser Family Foundation survey of states’ Medicaid family planning policies under fee-for-service finds wide coverage of most prescription contraceptives among 40 states and the District of Columbia (DC), but variable coverage of emergency contraceptives and other family planning-related services. It is the first published report on state coverage of family planning benefits since the passage of the Affordable Care Act (ACA).

The states surveyed all cover daily oral contraceptives, and most also cover other prescription contraceptive methods such as injectable contraceptives, the diaphragm, the patch, and vaginal ring. Coverage of long-acting reversible contraceptives such as intra-uterine devices and implants is widespread across states that participated in the survey, and few states put limits or restrictions on these devices or their removal. Furthermore, many states are experimenting with a variety of payment policies for long-acting reversible contraception provided immediately after labor and delivery.

Medicaid coverage of the over-the-counter emergency contraception product Plan B and other over-the-counter contraceptives is more limited than prescription methods. At least one form of emergency contraceptive pills is covered through traditional Medicaid programs in all but three surveyed states, but the over-the-counter product Plan B is covered in fewer states than ella, which is a prescription form of emergency contraception.  Coverage for other over-the-counter contraceptives is more limited than prescription methods: ten states do not cover condoms, spermicide, and sponges.

While virtually all states surveyed covered family planning-related services like contraceptive counseling, well women visits, and cervical and breast cancer screenings, fewer (35 out of 41) reported coverage for screenings for intimate partner violence. Only one state, Nebraska, covered fertility treatments for either women or men and this coverage was limited to infertility caused by medical issues.

The report, prepared by Health Management Associates and the Kaiser Family Foundation, features detailed data for 40 states and DC and looks at family planning benefits across full scope traditional Medicaid programs and Medicaid expansion under the Affordable Care Act (ACA), as well as limited scope Medicaid family planning programs.

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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.