Medicaid policy change and the association between insurance and postpartum permanent contraception fulfillment in West Virginia.

BACKGROUND

The federal 30-day waiting period for Medicaid-covered female permanent contraception (PC) is a known barrier to timely fulfillment. In July 2020, West Virginia became the first state to bypass this waiting period by using state funds to support procedures that do not meet the waiting period for federal funding.

OBJECTIVES

To assess changes in postpartum fulfillment of PC requests following West Virginia's 2020 Medicaid policy change.

DESIGN

We conducted a retrospective cohort analysis of patients who delivered at ⩾20 weeks of gestation at West Virginia University Hospital in 2019 and 2021, excluding 2020 due to the COVID-19 pandemic and implementation of the policy change.

METHODS

We used multivariable logistic regression to assess the association between insurance type and inpatient postpartum PC fulfillment, with interaction terms between year and insurance type to examine policy impact.

RESULTS

Among 423 patients desiring postpartum PC, 61.5% had PC fulfillment before hospital discharge. In 2019, fulfillment was significantly lower for Medicaid patients than those with other insurance (55.0% vs. 73.3%; RD: -0.19; 95% CI [-0.32, -0.06]). By 2021, this difference was no longer significant (54.9% vs. 68.3%; RD: -0.13; [-0.27, 0.003]). In adjusted stratified models for 2019 and 2021, there were no significant differences in odds of fulfillment between patients with Medicaid and other insurance (2019 aOR: 0.55; [0.23, 1.28]; 2021 aOR: 0.92; [0.38, 2.21]; likelihood ratio test p = 0.36).

CONCLUSION

West Virginia's policy change may have partially reduced one barrier to desired inpatient postpartum PC access; Medicaid fulfillment rates remained stable from 2019 to 2021, whereas fulfillment rates decreased for patients with non-Medicaid insurance. However, non-policy-level obstacles to inpatient postpartum PC remain prevalent.