In August, the Center for Medicaid and the Children’s Health Insurance Program (CHIP) Services (CMCS) released a CMCS Informational Bulletin (CIB) reiterating Medicaid enrollees’ right to access comprehensive family planning services without limitations on their choice of provider or their choice of covered contraceptive method. The CIB affirms CMS’ commitment to ensuring that all people enrolled in Medicaid have access to the family planning care they need free from pressure, coercion, or other unnecessary barriers.
The CIB provides strategies to enhance access to contraception, clarifies confidentiality requirements for those seeking family planning services, and shares recommended ways to measure quality in delivering family planning services. The CIB is especially important because it explicitly lists several best practices in different areas including coverage of over-the-counter (OTC) contraceptives and coverage of postpartum contraceptive care.
The best practices the CIB encourages states to utilize include many that NHeLP has long advocated for, including:
- Allowing for the prescription or provision of 6- to 12-months of contraception supplies
- Providing timely, patient-centered, and comprehensive coverage of contraceptive services
- Improving access to over-the-counter (OTC) contraception
- Paying directly for immediate postpartum LARC insertion and unbundle payment for this service from labor and delivery services.
OTC Contraceptive Best Practices
The CIB recommends that to make it easier for Medicaid enrollees to obtain OTC contraceptive drugs, states can issue statewide protocols or standing prescription orders for an OTC drug, so that pharmacists can issue prescriptions to Medicaid enrollees directly at the point-of-sale. (Numerous states like Illinois, Massachusetts, and Wisconsin use standing orders to allow pharmacists to prescribe certain OTC contraceptives to Medicaid enrollees.) The CIB also includes other ways states can expand pharmacists’ scope of practice, including allowing for independent prescribing or through a collaborative practice agreement. (NHeLP explores the billing mechanisms for these approaches here).
Importantly, the CIB recognizes that even with the advancement of OTC contraceptives, Medicaid enrollees still must often obtain a prescription to access OTC items. Pharmacist prescribing eliminates some of the logistical barriers Medicaid enrollees face when trying to access OTC contraceptives.
Postpartum Coverage Best Practices
Importantly, the CIB highlights that family planning is a part of high-quality, comprehensive postpartum care. It encourages states to adopt several best practices, including producing provider bulletins with prenatal care standards that include anticipatory guidance during the prenatal period on planning for contraceptive care after delivery; allowing same-day orders to facilitate access to LARCs immediately postpartum, without requirements to order LARCs before birth; and submitting a state plan amendment (SPA) to expand eligibility for Medicaid family planning services.
NHeLP has long advocated for states to submit SPAs to expand Medicaid family planning services. Expanding eligibility for these services provides an important coverage vehicle for low-income and underserved individuals who do not qualify for traditional Medicaid.
Conclusion
Ensuring access to family planning services is critical in the wake of Dobbs v. Jackson Women’s Health Organization, growing attacks on sexual and reproductive health care, and an incoming administration that is hostile to sexual and reproductive health care. While the CIB does not present new requirements, it encourages a number of best practices states can adopt to significantly expand access to contraception.
