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 30, 2024
BILL NUMBER: HB 1426 BILL AMENDED: Jan 30, 2024
SUBJECT: Long Acting Reversible Contraceptives.
FIRST AUTHOR: Rep. Fleming BILL STATUS: CR Adopted - 1
st
House
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
DEDICATED
XFEDERAL
Summary of Legislation: (Amended) The bill requires a hospital that operates a maternity unit to ensure
that a woman who is giving birth in the hospital and who meets certain criteria has the option, if not
medically contraindicated, of having a long-acting reversible subdermal contraceptive implanted after
delivery and before the woman 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 the hospital for the
following provided to a Medicaid recipient:
(1) A long-acting reversible subdermal contraceptive, including the cost of stocking the long
acting reversible subdermal contraceptive.
(2) Placement of the long-acting reversible subdermal contraceptive.
It provides that the reimbursement must be separate from, and in addition to, the reimbursement for maternity
services for the Medicaid recipient.
Effective Date: July 1, 2025.
Explanation of State Expenditures: (Revised) The bill’s requirement to reimburse providers for placing
a long-acting reversible subdermal contraceptive (subdermal LARC) separate from the maternity service fees
is estimated to increase state Medicaid costs between $5,040 and $10,325, assuming similar prenatal care
estimates as for FY 2022 and similar number of subdermal LARC placed as for FY 2023.
HB 1426 1 (Revised) Subdermal LARC Stocking: The bill will also increase state Medicaid costs for subdermal LARC
stock at hospitals, depending on administrative decisions of the Family and Social Services Administration
(FSSA) in providing reimbursement and on each hospital’s determination of the amount of stock needed.
(Revised) Additional Information - The following information was used to calculate the estimated cost.
• In SFY 2022, the FSSA reported that there were 39,700 live births and that 37,381 women received
prenatal care, suggesting that about 2,300 women would be covered by the provisions of the bill.
• The estimated number of professional services reimbursed by Medicaid under the bill was developed
from the general United States population uptake of LARC and actual Indiana Medicaid payments
for inpatient subdermal LARC implantation. The Centers for Disease Control (CDC) reported from
2017 to 2019, 10.4% of women aged 15 to 49 in the general population used LARC (not just
subdermal LARC). The low-end of the estimate was based on the CDC percentage applied to the
number of women potentially covered by the bill resulting in Medicaid paying for an additional 240
subdermal LARC implantations as a result of the bill. The high-end estimate reflects the 431
Medicaid paid subdermal LARC (CPT codes J7306 and J7307) implantations during an inpatient
stay in SFY 2023.
• The service fee in the 2024 fee-for-service (FFS) fee schedule for CPT code 11981, insertion of a
drug delivered implant, with a cost of $93.41 was used to estimate the professional fee cost of
implanting the subdermal LARC. The cost may be overstated to the extent that managed care entities
have a lower contractual rates than the FFS rate.
• Medicaid and the Children’s Health Insurance Program (CHIP) are jointly funded between the state
and federal governments. The state share of costs for most Medicaid medical services for FFY 2023
is 34%, 10% for the age 19 to 64 expansion population within the Healthy Indiana Plan (HIP), and
24% for CHIP. The state share of most Medicaid and CHIP expenditures is paid from state General
Fund appropriations, and state dedicated funds primarily cover HIP costs.
Subdermal 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.
Explanation of State Revenues:
Explanation of Local Expenditures: Locally owned hospitals may need to maintain subdermal 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; IHCP, BT202323, March
HB 1426 2 14, 2023; https://www.cdc.gov/nchs/products/databriefs/db388.htm; FSSA report 27896, Medicaid Births
Costs, 7/1/2021 to 6/30/2022, date of service based.
Fiscal Analyst: Karen Rossen, 317-234-2106.
HB 1426 3