OBJECTIVES: Medicaid reimbursement for long-acting reversible contraceptives (LARC) provided in the immediate post-partum period (IPP) during the same hospital visit as birth has historically been part of the diagnosis-related group (DRG) fee. To rectify the financial disincentive providers faced, some states implemented policies to reimburse hospitals for IPP-LARC in addition to the DRG fee. This study aimed to characterize outcomes associated with these Medicaid policies for the provision of IPP-LARC.

METHODS: A systematic literature review was conducted in November 2022 using Medline, EMBASE, and CINAHL. Outcomes of interest included LARC use rates, pregnancy or birth rate, and authors’ conclusions on the success of the policy.

RESULTS: Twenty studies investigating Medicaid carve-out policies across 13 states were included. The populations ranged from 22.2 to 31 years, were racially diverse, and attended primarily urban hospitals. Sixteen studies reported pre- and post-policy IPP-LARC uptake; those which calculated statistical significance (n=9) found increases in IPP-LARC uptake after policy implementation (p<0.05) except for two studies in Iowa where increases were non-statistically significant. Birth outcome studies (n=6) found a lower risk of short-interval pregnancies (p<0.05) except in a South Carolina population of adults which had no difference pre- vs. post-policy, although there was a significant difference in the study’s adolescent population (p<0.01). A key determinant of carve-out success at the hospital level was support from policy champions, or co-interventions aimed at increasing hospital staff training or raising awareness. However, the additional IPP-LARC payments were accessed inconsistently across hospitals within implementing states, and smaller, rural, and religiously affiliated institutions were less likely to leverage the change in reimbursement.

CONCLUSIONS: Medicaid’s IPP-LARC reimbursement carve-outs are effective at increasing LARC usage and reducing short interval pregnancies; however, states can improve policy implementation by providing additional support and training in hospitals, and support to women in vulnerable positions.