SEA 252
By: Kalina Dickinson, Communications Intern
Great news, Hoosiers!
During the 2023 Legislative Session, SEA 252, a bill we advocated for and supported, was passed. This bill enables long acting reversible contraceptives (LARCs) that were ordered and uncollected by one Medicaid recipient to be transferred to another Medicaid recipient if certain requirements are met. In other words, this bill will reduce LARC waste, as these products become expired and then discarded, save money, and allow quicker access to other patients who may want to do same-day insertion.
One supported testimony for SEA 252 was Missouri’s House Bill 1499, a similar bill that allowed unused LARCs to be given to another patient, which saved 1.8 million dollars since its enactment. And according to a study by Indiana University School of Medicine doctors, same-day LARC insertions led to overall lower costs for the patients. Rather than paying around $4,133 for two visits, the patient would only need to pay about $2,016 for the first visit.
However, while SEA 252 is a medical waste bill that saves money and helps some patients obtain a same-day insertion, it does not help all patients, nor does it solve the underlying issue: the logistical barriers to LARC access that are causing these contraceptives to not be collected in the first place.
Some barriers that women, particularly poor, working, and/or rural women, face when scheduling an appointment are finding transportation, time off work, and child care. Making one appointment is hard enough, but making a second one is even harder. And with most clinics, obtaining a LARC often leads to scheduling a second appointment. Due to the logistical barriers, up to 50% of patients don’t return to have their LARC inserted, hence the enactment of SEA 252.
Another barrier that women face is not having adequate information or knowledge about LARCs, causing these women to feel nervous or intimidated to come back for a second appointment. Additionally, because of this lack of knowledge, women come into their first appointment unsure of which contraceptive method they want, resulting in a second appointment. Thus, it is important to provide women with information regarding methods before an appointment so that a same-day insertion can occur. One way to facilitate this is to provide staff with a brief scripts exploring which contraceptive methods, if any, interest a patient.
Previous studies also show that, despite LARCs safety, effectiveness, high rates of patient satisfaction, and increase in their use in recent years, women with Medicaid coverage were one of the few groups that did not see an increase in utilization. Between 2009 and 2012, use of LARCs among Medicaid-covered women remained fairly flat at 11.0%, whereas the prevalence of LARC use among women with private insurance and “other” coverage increased to 11.1% (up from 7.1%) and 14.0% (up from 8.0%), respectively. This is because the logistical barriers have a greater impact on women on Medicaid, who are often low-income or working individuals.
However, even if same-day insertion is available, there are additional barriers before a recipient can receive a LARC, such as checking insurance status and benefits, verifying that they are not currently pregnant, and going through STI screening. Again, this could discourage women from coming back and getting an insertion.
Family planning is a basic human right that enables women’s empowerment, but barriers and waiting periods restrict these freedoms. Especially in Indiana, a contraceptive desert where 428,540 women live in counties that lack reasonable access to the full range of methods and 102,580 women live in counties without a single health center that provides the full range of methods; it is vital to have easy access to contraceptives like LARCs. Therefore, we must fight for and support reproductive accessibility for all women.
Path4You:
Path4You is a great resource that helps combat these logistical barriers for women. This online program aims to provide all people in Indiana with high-quality, non-coercive, patient-centered, and free comprehensive access to contraception. This includes all birth control options—from natural family planning to pills to long-acting reversible contraception (LARCs). The program has three pillars, in which they provide universal pregnancy intention screening, comprehensive contraceptive counseling and decision support, and same-day contraceptive method access.