Removal

Women using LARC methods must always be free to discontinue use, even absent a medical reason for doing so. Additionally, there may be medical reasons or side effects that require removal of LARC methods. Federal law reflects these standards of care. As discussed in the section on coverage eligibility, all commercial plans and Medicaid ABPs subject to the ACA’s contraceptive coverage requirements must also cover LARC method removal without cost-sharing. Additionally, federal Medicaid law requires coverage of medically necessary services and provides that each individual be free from coercion or mental pressure and free to choose her method of family planning.

In spite of these requirements, providers may encounter problematic coverage or reimbursement policies for removal of LARC methods. For example, some public or commercial plans may have payment policies (e.g. bundled payments, global payments) that, in effect, deny separate reimbursement for removal in some contexts. Providers should consult state Medicaid provider manual(s) or plan materials for details about a particular plan’s coverage policies.

Some states have also been known to deny coverage of IUD removal absent a medical justification. If your state Medicaid program does not cover removal of LARC methods, or if your state places inappropriate limits or restrictions on removal, please email NHeLP at nhelp@healthlaw.org with “reproductive health” in the subject line.