LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 7052 NOTE PREPARED: Jan 8, 2024
BILL NUMBER: HB 1426 BILL AMENDED:
SUBJECT: Long Acting Reversible Contraceptives.
FIRST AUTHOR: Rep. Fleming BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
DEDICATED
XFEDERAL
Summary of Legislation: The bill requires a hospital that operates a maternity unit to ensure that a Medicaid
recipient giving birth in the hospital has the option of having a long acting reversible contraceptive implanted
after delivery and before the Medicaid recipient is discharged. It allows a hospital to be exempt from the
requirement if the hospital has a faith based objection.
The bill requires the Office of the Secretary of Family and Social Services to reimburse a hospital for the
following provided to a Medicaid recipient:
(1) A long acting reversible contraceptive, including the cost of stocking the long acting reversible
contraceptive.
(2) Insertion or placement of the long acting reversible contraceptive.
The bill provides that the reimbursement must be separate from, and in addition to, the reimbursement for
maternity services for the Medicaid recipient. It specifies the reimbursement rate for insertion or placement
of the long acting reversible contraceptive.
Effective Date: July 1, 2025.
Explanation of State Expenditures: The bill’s requirement to reimburse providers for placing a long acting
reversible contraceptive (LARC) separate from the maternity service fees will increase state costs for the
Medicaid program by between $8,200 and $9,150, assuming a similar number of devices placed as in FY
2023.
The bill will also increase state Medicaid costs for LARC stock at hospitals, depending on administrative
HB 1426 1 decisions of Family and Social Services Adminisration (FSSA) in providing reimbursement and on the
hospital’s determination of the amount of stock needed.
Additional Information -
Provider Service Fees: The estimated increased cost for provider services is based on the number of LARC
devices paid in FY 2023 for pregnancy or maternity patients in an inpatient setting, and the state share was
determined by the mix of standard and Healthy Indiana Plan (HIP) payments. The state share of costs for
most Medicaid medical services for FFY 2024 is 34% and 10% for the age 19 to 64 expansion population
within the HIP. The service fee is based on the 2024 fee-for-service (FFS) fee schedule for CPT codes 11981
and 58300, with costs of $93.41 and $104.06, respectively. The cost may be overstated to the extent that
managed care entities have a lower contractual rates than the FFS rate. There was a 468% increase in the
number of LARC devices placed in an inpatient setting between FY 2022 and FY 2023.
LARC Stocking: The amount of stock needed will depend on the forecasted need at each hospital, which will
take into account the utilization, provider preferences, and device costs. A hospital may participation in the
340 B or other pharmacy benefit program that may reduce the cost of the stock devices. In FY 2023, the
average devices cost was $1,071 for the 375 devices inserted.
Explanation of State Revenues:
Explanation of Local Expenditures: Locally owned hospitals will need to maintain LARCs to comply with
the bill.
Explanation of Local Revenues:
State Agencies Affected: FSSA
Local Agencies Affected: Locally owned hospitals.
Information Sources: American College of Obstetrics and Gynecology, Long-Acting Reversible
Contraception (LARC) Administrative and Infrastructure Support (in-office & hospital use); FSSA data
warehouse of claims and encounters; Physician Indiana Medicaid Fee Schedule.
Fiscal Analyst: Karen Rossen, 317-234-2106.
HB 1426 2