Investigating the effect of Medicaid unbundling of LARC on inpatient provision of LARC devices after childbirth in Iowa, Maryland, and New York
Awarded 2019
Emerging Scholars in Family Planning
Renee Kramer, MPH
University of Wisconsin-Madison

Provision of long-acting reversible contraceptives (LARCs) before women leave the delivery hospital can be difficult for health care systems to achieve due to the high costs of devices and insertion. In response to challenges with the global fee for labor and delivery services, 37 states since 2012 have established mechanisms to provide appropriate reimbursement for immediate postpartum LARC provision. In this study, I propose to use an Interrupted Time Series (ITS) design with a comparison series to separately examine the effect of unbundling on inpatient LARC provision in three US states that implemented unbundling in 2014: Iowa, New York, and Maryland. The study population includes women in these three case states and in four control states (Colorado, Kentucky, Michigan, and New Jersey) who had a Medicaid-covered hospital visit for labor and delivery in the State Inpatient Databases (SID) between January 1, 2013 and December 31, 2015. In addition to understanding the main effect of unbundling on inpatient LARC provision, I also seek to examine which characteristics at the hospital level are the strongest drivers of level and trend in inpatient LARC following the unbundling policy change, as well as which patients are most affected by unbundling. Results from this study could encourage state Medicaid administrators who have not yet implemented unbundling to do so; provide insight into the health systems factors that may help or hinder rollout of the policy change on the ground; and reveal important patterns in who is most likely to benefit from unbundling.