METHODS: We used 2013 Medicaid claims data to calculate the number of female Medicaid recipients at risk for unintended pregnancy (UIP) who adopted or continued use of: 1) the most effective (i.e. female sterilizations, implants, intrauterine devices [IUDs]) or moderately effective (i.e. injectables, oral pills, patch, ring, or diaphragm) FDA-approved contraceptive methods, 2), a subset of measure 1, an FDA-approved, long-acting reversible contraception (LARC) (IUD or implant). We compared the results for each measure for Medicaid fee for service vs. Iowa’s two managed care organizations (MCOs). In 2013, MCO 1 comprised 8.6% of Medicaid women of reproductive age (WRA) with clients throughout the state. MCO 2 comprised 1.3% of Medicaid WRA with clients primarily in eastern Iowa.
RESULTS: Using Medicaid paid claims, the percentage of women ages 15-20 and 21-44 (age groups based on Medicaid core set age cut-offs) who adopted or continued use of the most effective or moderately effective FDA-approved contraceptive methods was 61.8% and 59.9%, respectively. The percentage of women who adopted or continued use of a LARC was 8.5% for women ages 15-20 and 9.6% for women ages 21-44. The percentage of women who adopted or continued use of a most or moderately effective contraceptive method was highest among Medicaid fee for service clients (63.1%), followed by MCO1 (37.1%) and MCO2 (30.0%). The percentage of women who adopted or continued use of a LARC was also highest among Medicaid fee for service clients (9.7%), followed by MCO1 (6.5%) and MCO2 (3.7%).
CONCLUSIONS: In 2016, Iowa Medicaid will transition from fee-for-service to a completely managed care system. We will use these contraceptive measures to monitor the new MCOs efforts to increase access to the most and moderately effective contraceptive methods among women at risk for UIP. The application for measure endorsement is due for submission in February of 2016.