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: Feb 1, 2024
BILL NUMBER: HB 1426 BILL AMENDED: Feb 1, 2024
SUBJECT: Long Acting Reversible Contraceptives.
FIRST AUTHOR: Rep. Fleming BILL STATUS: 2nd Reading - 1st 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:
(1) giving birth in the hospital; and
(2) eligible for or receiving Medicaid assistance;
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 also 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.
The bill 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 $10,325 and $87,000, assuming similar prenatal care
estimates as for FY 2022 and similar number of subdermal LARC placed as for FY 2023.
HB 1426 1
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.
Additional Information - The following information was used to calculate the estimated cost.
• The FSSA reported that Medicaid reimbursed 39,700 live births in SFY 2022.
• 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 reflects the 431 Medicaid paid subdermal LARC
(CPT codes J7306 and J7307) implantations during an inpatient stay in SFY 2023. The high-end
estimate was based on the CDC percentage applied to the number of live births reimbursed by
Medicaid resulting in Medicaid paying for an additional 4,130 subdermal LARC implantations as
a result of the bill.
• 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.
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