Wellness
State Medicaid Strategies for the Contraceptive Care Workforce
States are using a variety of strategies to identify and reimburse the contraceptive care workforce.
The post State Medicaid Strategies for the Contraceptive…
States are using a variety of strategies to identify and reimburse providers and community-based supports for contraceptive counseling and care. There are many health and economic benefits of preventing unintended pregnancy with contraception, with different types of providers creating access to these services.
State Medicaid Strategies for Reimbursing Licensed and Community-Based Providers in Contraceptive Care
Certified Nurse-Midwives
In 2019, through a state plan amendment (SPA), Michigan updated its Medicaid payment policy to reimburse certified nurse-midwives for an expanded range of services, including contraception services. Covered professional services include those within certified-nurse midwives’ scope of practice as defined in state law and must be administered with an agreement that provides for physician consultation and referral. To reduce gaps in medication continuation, in 2022 Michigan updated the contraceptive supply limit in its Medicaid program to allow up to a 12-month supply of prescribed contraceptives, include oral contraceptives, vaginal ring, and contraceptive hormonal patches.
Community Health Workers
More than half of states reimburse for community health workers or provide services through Medicaid managed care.
In Washington, DC, the Mothers Rising Home Visitation Program run by the community-based organization Mamatoto Village provides expectant and new parents with comprehensive home visiting services during pregnancy and postpartum. Several Medicaid managed care organizations cover services provided as part of the program, which include counseling, doula care, home visiting from a perinatal community health worker, wellness coaching, parent education, and lactation support. Among many maternal and infant health topics, Mamatoto’s Perinatal Community Health Worker curriculum includes training on contraceptive counseling and fertility awareness.
Doulas
Doula care includes support during pregnancy and the postpartum period. Currently, 10 states provide Medicaid coverage for doula services statewide.
In 2022, Virginia began offering doula services as a benefit for Medicaid members. To be reimbursed, doulas must complete several actions, including applying for state certification. The state certification application sets forth a knowledge requirement, which includes service coordination related to family planning and education around birth planning and informed decision-making. Doulas are reimbursed for each prenatal and postpartum visit separately and are eligible for an additional value-based incentive payment if they perform at least one postpartum service visit and the client is seen by an obstetric clinician for one postpartum visit after a labor and delivery claim. A second value-based incentive payment is available if the doula performs at least one postpartum service visit and the newborn is seen by a pediatric clinician for one visit after a labor and delivery claim.
Virginia Invests in Doulas to Improve Maternal Health Outcomes
Licensed Midwives
According to a 2022 NASHP 50-state analysis, 18 states offer Medicaid reimbursement for services provided by midwives without a nursing degree.
In Washington state, midwives who do not have a nursing degree are called licensed midwives. To be a Medicaid agency-approved provider, licensed midwives must meet several educational and experience requirements. Licensed midwives in the state can provide a variety of services in addition to prenatal care and labor and delivery, including pregnancy and birth counseling and postpartum care for up to eight weeks after delivery. They also can prescribe cervical caps and diaphragms.
Pharmacists
A 2021 survey of Medicaid programs revealed at least 11 states (CA, CO, HI, ID, MD, OR, ND, TN, VT, WA, WV) allow pharmacists to prescribe family planning products, and in eight states (CA, CO, ID, MD, OR, TN, WA, WV), Medicaid reimburses for a contraceptive visit.
In 2017, statewide regulations authorizing trained and licensed pharmacists in New Mexico to prescribe contraception went into effect, allowing individuals to have birth control prescribed and filled by a pharmacist in a single visit. In 2020, the state legislature passed legislation requiring insurers to reimburse certified pharmacist clinicians and pharmacists certified to prescribe medications, including contraception, at the same level as other covered providers such as physicians or physician assistants. This law includes managed care organizations contracting with the state’s Medicaid program.
What Are Key Barriers to Contraceptive Care Access?
An analysis found that more than 19 million women of reproductive age in the U.S. who are in need of publicly funded contraception live in contraceptive deserts, defined as areas with less than one health center for every 1,000 women in need of publicly funded contraception. Approximately 1.2 million of these women live in a county without a single health center offering the full range of contraceptive methods. This lack of access poses a barrier to those seeking contraceptive care.
A 2022 report on maternity deserts found over 1,200 counties in the U.S. had no obstetrician, certified nurse-midwife, or certified midwife in 2019, with no obstetrician in nearly half of all counties (47.9 percent) and no certified-nurse midwife in over half (55.1 percent) of all counties. These differences were uneven across the country, as rural counties had nearly half as many obstetric providers per 10,000 births as compared to urban counties. Maternity deserts affect access to postpartum care, including contraceptive counseling.
What Types of Providers Offer or Support Contraceptive Care?
A range of clinical primary care providers (physicians, physician assistants, nurses) who offer routine well-care visits and sick care, as well as obstetric care providers (including physicians and certified nurse-midwives) who specialize in care during pregnancy, labor, and delivery offer contraceptive counseling and can provide contraceptive care. Depending on state laws, pharmacists also can provide contraceptive counseling and prescribe contraception. Finally, community-based providers such as midwives without a nursing degree, doulas, and community health workers also can offer contraceptive counseling and help connect patients to contraceptive care.
For the Purposes of This Explainer:
Certified Nurse-Midwives
Certified nurse-midwives refer to professionals with a nursing degree who work in partnership with patients to give the necessary support, care, and advice during pregnancy, labor, and the postpartum period to conduct births and to provide care for the newborn and the infant. Certified nurse-midwives can prescribe medications and practice in all settings, including hospitals, offices, birth centers, and homes.
Community-Based Providers
Midwives are professionals who work in partnership with patients to provide needed support, care, and advice during pregnancy, labor, and the postpartum period. For the purposes of this explainer, the term refers to professionals without a nursing degree. Terminology and practice settings vary across states. Terms include licensed midwives, direct-entry midwives, and certified professional midwives.
Doulas refer to trained professionals who provide continuous physical, emotional, and informational support to their client before, during, and shortly after childbirth.
Community health worker is an umbrella term and includes community health representatives, promotores, peers, and other workforce members who are frontline public health professionals that share life experience, trust, compassion, and cultural and value alignment with the communities where they live and serve.
What Is Contraceptive Counseling?
This product was made possible through generous support from Arnold Ventures.
The post State Medicaid Strategies for the Contraceptive Care Workforce appeared first on NASHP.
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