Federally Qualified Health Centers (FQHCs) are community-based providers that exist to meet patients where they live and provide the primary care services they need. With approximately 12,000 service delivery sites located across the country. FQHCs serve a large number of both insured and uninsured patients. FQHCs have sliding fee scales for uninsured patients to make care affordable and accessible.
As part of their mandate to provide primary care services, FQHCs deliver publicly funded family planning care to approximately 2 million women each year. However, these health centers can face unique challenges to offering long-acting reversible contraceptives (LARCs), meaning that not all FQHC patients have access to the full range of FDA-approved contraceptive methods.
Medicines360, with Waxman Strategies and Camber Collective, conducted research to identify these challenges through surveys and interviews with providers, administrators, and policy stakeholders between January 2019 and June 2019. Addressing these challenges would extend greater contraceptive choice to larger numbers of safety-net patients across the country.
In a white paper published this month, we provide the following recommendations:
- Provide targeted training and technical assistance. FQHCs should be given expanded access to clinical training and technical assistance on topics relating to family planning, including patient-centered counseling and services for LARC methods alongside the full range of FDA-approved contraceptive methods, consistent with national quality family planning (QFP) guidelines.
- Protect and expand grant programs and the use of evidence-based guidelines. On top of sustaining funding levels for Title X and Section 330, policymakers should consider safeguarding Title X’s evidence-based guidelines and clarify that FQHCs should provide affordable access to all 18 FDA-approved methods of contraception.
- Collect and report data on family planning care provided at FQHC sites. The federal government should collect, analyze, and report detailed data on the performance of FQHCs in the family planning context and measure their impact.
- Design optimal Medicaid reimbursement rates policies. Since Prospective Payment System (PPS) encounter rates are often too low to cover the cost of LARC-related care at FQHCs, policymakers should consider unbundling or “carving out” LARC product and service reimbursements from PPS rates.
- Reform state scope-of-practice and licensing laws. Although non-physician clinicians such as advanced practice registered nurses (APRNs) are trained in the provision of a range of services, various legal and reimbursement challenges may prevent them from helping to meet the need for family planning. State policymakers should consider removing barriers for non-physician clinicians.
- Enhance collaboration, training, and sharing of best practices. States should convene key family planning stakeholders into LARC learning collaboratives to establish referral systems, share resources, identify trainers, and share best practices on patient-centered counseling and services. These collaboratives should build on the insights of past efforts, such as the Increasing Access to Contraception Learning Community
To learn more about the research methodology, findings, policy recommendations, the full white paper is accessible here.