Assessing the Gap Between the Cost of Care for Title X Family Planning Providers and Reimbursement from Medicaid and Private Insurance
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- The Guttmacher Institute analyzed data on costs and reimbursement from Title X providers representing more than 350 health centers serving more than 900,000 contraceptive clients.
- The analysis compared costs and reimbursement for 20 procedure codes commonly used by family planning providers, for three types of payers: Medicaid fee-for-service, Medicaid managed care plans and private insurance plans.
- For patient visits, the median Medicaid fee-for-service reimbursement was 45–49% of the actual cost of providing that care. Medians for insertion and removal of long-acting reversible contraceptives (IUDs and implants) were somewhat higher, at 49–74%.
- Reimbursement under Medicaid managed care was typically lower than that under Medicaid fee-for-service. The managed care plans paid a median of 41–46% of actual costs for patient visits and 27–33% of costs for IUD insertion and removal.
- Private insurance reimbursement was typically slightly higher than Medicaid fee-for-service reimbursement. Private plans paid a median of 55–58% of actual costs for patient visits, and 53–74% of costs for IUD and implant insertion and removal.
- Many providers’ experiences varied considerably from these medians. Yet, few providers reported being reimbursed in full for any of the 20 procedure codes analyzed, from any payer.
This report was accompanied by a news release.