Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;103(4):255-260.
doi: 10.1016/j.contraception.2020.12.012. Epub 2020 Dec 28.

Variation by state in Medicaid sterilization policies for physician reimbursement

Heather Bouma-Johnston  1 , Roselle Ponsaran  2 , Kavita Shah Arora  3
Affiliations

Variation by state in Medicaid sterilization policies for physician reimbursement

Heather Bouma-Johnston et al. Contraception. 2021 Apr.

Abstract

Objective: To evaluate state-level variation in Medicaid sterilization reimbursement policies for physicians in terms of policy details, flexibility, and review process.

Study design: We reviewed state Medicaid websites and interviewed state employees to better understand reimbursement policies and implementation. We attempted to obtain policy details and instructions for physicians from all 50 state Medicaid office websites. We invited employees in all 50 state Medicaid director's offices to participate in semi-structured qualitative interviews.

Results: We were able to collect data from 48 states' websites for analysis, conducted 15 telephone interviews, and received 4 written responses from state Medicaid employees. State policies varied greatly in terms of degree of instruction available online to clinicians, number of content-related and logistical changes made compared to the federal policy, type of procedures included, corrections permitted, flexibility in terms of surgeon and procedure changes, review process, reasons for and ramifications of denial, and date of last policy revision.

Conclusion: There is need for increased transparency and instruction by state Medicaid offices as well as revision of the Medicaid policy to account for the contemporary clinical practice of female permanent contraception. Clinicians should communicate with state Medicaid employees in order to clarify important policy details and obtain greater understanding of their state's review process and ramifications to ensure their clinical practice is both correct and reimbursable.

Implications: Greater consistency between states in terms of Medicaid policy and implementation is crucial to ensuring physicians are fairly reimbursed for their work, and female permanent contraception remains an accessible contraceptive method for women.

Keywords: Disparity; Health policy; Informed consent; Medicaid; Permanent contraception; Postpartum contraception.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Centers for Medicare & Medicaid Services, HHS. Title 42 Code of Federal Regulations (CFR) 441, Subpart F § 441.250-259. Source 43 FR 52171 (1978).
    1. Block-Abraham D, Arora KS, Tate D, Gee RE. Medicaid consent to sterilization forms: Historical, Practical, Ethical, and Advocacy Considerations. Clin Obstet Gynecol 2015;58(2):409–17. - PubMed
    1. Brown BP, Chor J. Adding injury to injury: ethical implications of the Medicaid sterilization consent regulations. Obstet Gynecol. 2014;123(6): 1348–51. - PubMed
    1. ACOG. Access to Postpartum Sterilization. American College of Obstetrics and Gynecologists Committee; Opinion Number 530. July 2012;120(1):212–215. - PubMed
    1. Thurman AR, Janecek T. One-year follow-up of women with unfulfilled postpartum sterilization requests. Obstet Gynecol. 2010;116:1071–7. - PubMed

Publication types