MAINSTREAMING CONTRACEPTIVE SERVICES IN MANAGED CARE - 5 STATES EXPERIENCES

Context: The ongoing, rapid national transition from a health care fin ancing and delivery system dominated by traditional indemnify insuranc e to one dominated by managed care has enormous implications for the a ccessibility of contraceptive services. Methods: In each of five areas with relatively mature managed care environments (all of Colorado, Ma ssachusetts and Michigan, as well as selected counties in California a nd Florida), all managed care organizations serving commercial or Medi caid enrollees were asked about their coverage of contraceptive servic es and the procedures for obtaining that care. In addition, all public ly funded family planning agencies in these areas were queried about t heir involvement with managed care plans, and representative samples o f reproductive-age women at risk of unintended pregnancy and enrolled in managed care plans were asked about their plan's coverage and their experiences in obtaining contraceptive services. Results: Fifteen per cent of health maintenance organizations and point-of-service plans di d not coverall five of the most commonly used medical contraceptive me thods, and another 6% covered none of the methods. Only half the plans informed enrollees-and even fewer informed enrollees insured indirect ly as dependents-of whether they covered contraceptive services. One i n four women in commercial plans were unsure whether their plan covere d oral contraceptives, and two in three did not know if their plan cov ered the other medical methods. Only one in four commercial plans have brought community-based family planning providers into their networks , and more than half of all publicly funded family planning agencies r eported having no contracts with managed care organizations. Finally n early one in three women in managed care plans reported difficulties i n obtaining contraceptive services, with 13% of enrollees in commercia l plans waiting at least four weeks for an appointment for contracepti ve care. Conclusions: To adequately address the contraceptive needs of their employees, employers must ensure that the health insurance plan s they purchase provide adequate coverage of contraceptive methods. Fo r their part, managed care organizations and state Medicaid programs s hould examine their policies and procedures to ensure that services ar e easily accessible to women needing contraceptive care.