Family planning providers and health plans express broad support for efforts to integrate family planning and managed care using health equity and payment and delivery reform principles

Newswise – WASHINGTON (March 22, 2022) –A major new report from researchers at George Washington University details findings from the second phase of a landmark study of Medicaid-managed care and family planning services. Coming 40 years after Congress enacted special protections to preserve access to family planning services for beneficiaries enrolled in Medicaid managed care, the study found virtually universal consensus on the value of integrating family planning and managed care.

The study also revealed widespread interest from plans and providers in efforts to improve access and quality of family planning using the delivery and payment reform tools of modern systems. Medicaid managed care.

“The special family planning access protections enacted in 1981 remain as important today as they were when they became law on a bipartisan basis,” said Sara Rosenbaum, Harold and Jane Hirsh Professor of Law. and health policy at the GW Milken Institute School of Public Health. , noted. “At the same time, we have been impressed with the extent to which plans and providers view family planning as an essential part of Medicaid-managed care and have embraced inclusiveness and innovation through delivery reform. and payment.”

Rosenbaum is the lead author of the report, which was funded by Arnold Ventures.

The study is the second phase of a nearly two-year project on Medicaid managed care and family planning. The phase two report presents the results of interviews with 10 health plans and 14 providers in 11 states that rely heavily on Medicaid-managed care.

Main findings

  • Network membership is standard for community health centers and family planning providers only; however, access to out-of-network family planning care remains an extremely important safeguard for Medicaid recipients. However, because state policies on the “freedom of choice” provision lack clarity, plans and providers report confusion regarding the scope of services covered when provided by out-of-network providers, thereby limiting the meaning of protection. The main confusing services include treatment for sexually transmitted diseases, vaccinations to prevent cancer, and important types of preventive reproductive counseling such as HIV-related counselling.
  • Despite the benefits of the “freedom of choice” guarantee, states, plans, and providers all seem to value and pursue the integration of family planning as a core feature of Medicaid-managed care. Given this widespread support, states could encourage a strong approach to including family planning providers as a basic contractual expectation.
  • Plans and providers express strong interest in pursuing delivery and payment reforms designed to address key family planning access issues such as scope of care or availability of service sites and programs for special populations. Reform strategies could encourage and reward innovations that expand sites and hours of service, use of mobile clinics, expansion of transportation and translation services, and improved follow-up care for some high-risk patients. risk.

The study makes a series of recommendations to strengthen family planning at a critical time for reproductive health and health equity. Importantly, the study recommends that federal Medicaid officials revise a policy issued in 2016 that could seriously impede access to some of the most important family planning services, particularly sexually transmitted disease treatment, assessment, and HIV counseling and human papillomavirus vaccination. . All of these services are traditionally provided in family planning settings and should definitely be covered as part of Medicaid’s family planning service package, the authors said.

The “Family Planning and Medicaid Managed Care Integration, Phase 2 Report: Insights from the Field” report is available here.


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