Medicaid, the largest payer for publicly funded contraception, accounts for 75 percent of all public funds spent on contraceptive services and supplies.

In Health Affairs, Maria Rodriguez and colleagues examine newly available 2018 Medicaid claims data and find "substantial place-based inequities in contraceptive use and provision across the US" among Medicaid beneficiaries.

Age-adjusted county-level rates of most or moderately effective contraceptive use varied from a low of 10.8 percent to a high of 44.4 percent and rates of long-acting reversible contraception varied from a low of 1.0 percent to a high of 9.6 percent.

The authors consider a variety of factors at the individual, state, and state Medicaid program levels that may cause the variation, and note the large state-level variations they observe suggest "state-level actions might be an important lever to promote contraceptive choice."

Today in Forefront, Sean Sullivan and coauthors argue valid alternatives to the QALY exist that will facilitate explicit consideration of both quality and length of life in comparative effectiveness assessments.

Also, Tara Straw writes about exchange operational standards and APTC policies for the third and final installment of a series on the final 2024 payment rule.

Read the first part from Sabrina Corlette on insurance market rules here. Read the second part from Matthew Fiedler on risk adjustment here.

Read more on Forefront and learn more about how you can contribute to the publication.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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