Medicaid Claims for Contraception Among Women With Medical Conditions After Release of the US Medical Eligibility Criteria for Contraceptive Use

Abstract

Introduction: The US Medical Eligibility Criteria for Contraceptive Use (MEC) identified 20 medical conditions that increase a woman's risk for adverse outcomes in pregnancy. MEC recommends that women with these conditions use long-acting, highly effective contraceptive methods. The objective of our study was to examine provision of contraception to women enrolled in Medicaid who had 1 or more of these 20 medical conditions METHODS: We used Medicaid Analytic Extract claims data to study Medicaid-enrolled women who were of reproductive age in the 2-year period before MEC's release (2008 and 2009) (N = 442,424) and the 2-year period after its release (2011 and 2012) (N = 533,619) for 14 states. We assessed 2 outcomes: provision of family planning management (FPM) and provision of highest efficacy methods (HEMs) for the entire study population and by health condition. The ratio of the after-MEC rate to the before-MEC rate was used to determine significance in MEC's uptake.

Results: Outcomes increased significantly from the before-MEC period to the after-MEC period for both FPM (1.06; lower bound confidence interval [CI], 1.05) and HEM (1.37; lower bound CI, 1.36) for a 1-sided hypothesis test. For the 19 of 20 conditions we were able to test for FPM, contraceptive use increased significantly for 12 conditions, with ratios ranging from 1.05 to 2.14. For the 16 of 20 conditions tested for HEM, contraception use increased significantly for all conditions, with ratios ranging from 1.19 to 2.80.

Conclusion: Provision of both FPM and HEM increased significantly among women with high-risk health conditions from the before-MEC period (2008 and 2009) to the after-MEC period (2011 and 2012). Health policy makers and clinicians need to continue promotion of effective family planning management for women with high-risk conditions.

Figure 1

Changes in percentage of women, by medical condition, with a Medicaid claim for family planning management from the 2-year period before (2008 and 2009) to the 2-year period after (2011 and 2012) the 2010 release of the US Medical Eligibility Criteria for Contraceptive Use (MEC) by the Centers for Disease Control and Prevention (1). Percentage is number of women with each medical condition and an FPM Medicaid claim relative to the total population for that condition.

Figure 2

Changes in percentage of women, by medical condition, with a Medicaid claim for a highest efficacy contraception method from the 2-year period before (2008 and 2009) to the 2-year period after (2011 and 2012) the 2010 release of the US Medical Eligibility Criteria for Contraceptive Use (MEC) by the Centers for Disease Control and Prevention (1). Highest efficacy methods are contraceptive implants, intrauterine devices, and sterilization. Percentage is number of women with each medical condition and an HEM Medicaid claim relative to the total population for that condition.