Public funding and policies for provision of the contraceptive implant, fiscal year 1992

Abstract

According to results of a survey of state Medicaid, health and welfare agencies, these agencies spent $61 million in federal and state funds on the provision of the contraceptive implant to low-income women in FY 1992. Some $57 million of this was federal funds, with Medicaid accounting for 84% of all public funds spent on the implant; only nine states committed monies from their own coffers. The Medicaid agencies of 13 states reported restrictions on the number of subsidized implants a woman could receive over her reproductive lifetime. No Medicaid agency has provisions to cover required or requested removals of the device among users who become ineligible for Medicaid while the implant is in place; only eight health departments have policies ensuring subsidized removals for such women.

PIP: Made available to the public for the first time in February 1991, Norplant is the first contraceptive implant approved for use in the US. The implant provides women with continuous contraceptive protection, is fully reversible, and is not coitus-dependent. Data from Wyeth-Ayerst Laboratories, the distributor for the US, indicate that 750,000 kits had been inserted as of July 1993. People, however, question the degree to which users may be dependent upon providers, particularly for implant removal, and about the potential for coercive public policies targeted to members of lower socioeconomic classes. By January 1993, all fifty states and the District of Columbia had approved the implant for reimbursement under their Medicaid programs. This paper reports findings of a survey conducted to assess levels of public funding for the provision of Norplant and the development of policies under which these funds are made available. The survey found that state Medicaid, health, and welfare agencies spent $61 million in federal and state funds providing Norplant to low-income women in fiscal year 1992. $57 million of the outlay was federal, with Medicaid accounting for 84% of all public funds spent on the implant; only nine states committed state funds. Medicaid agencies of a woman could receive over her reproductive lifetime. Further, no Medicaid agency has provisions to cover required or requested removals of the devices among users who become ineligible for Medicaid while the implant is still in place. Only eight health departments have policies ensuring subsidized removal for such women.