Call for Early Postpartum Long-Acting Reversible Contraception in North Carolina
To the Editor— In 2011, 45% of pregnancies in the United States were unintended or mistimed . As highlighted in the latest issue of the North Carolina Medical Journal , unintended pregnancy has an effect on upward mobility for women in North Carolina [2, 3]. One way that women's health providers are trying to address this issue is by increasing access to long-acting reversible contraception (LARC) devices during the postpartum period. Instead of waiting until an outpatient postpartum clinic visit, physicians are offering new mothers who desire these methods the option of LARC device insertion prior to hospital discharge following delivery. Medicaid programs in at least 19 states are providing this service to women, but it is not yet available in North Carolina . Early postpartum LARC is not currently provided in North Carolina because of billing arrangements and financial hurdles. Most health insurance plans, including Medicaid, pay for the delivery hospitalization in 1 bundled payment. LARC devices are too expensive to be lumped into that reimbursement. Medicaid programs in other states have created separate codes to allow billing for the device and the procedure in the hospital . While North Carolina Medicaid is in the process of addressing this need, our team sought to take steps towards providing this service now. At the Mountain Area Health Education Center (MAHEC) and Mission Hospital in Asheville, we are invested in lowering barriers to LARC. We therefore conducted a pilot project of early postpartum inpatient Nexplanon insertions, both to develop protocols in preparation for…
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