Tennessee’s Medicaid program is taking aim at the state’s rising number of drug-dependent newborns by expanding access to long-acting birth control implants.
The state’s prescription painkiller epidemic is the underlying problem. Babies born to mothers hooked on opiates often suffer withdrawals, known as neonatal abstinence syndrome. According to the latest figures, 93 percent of all NAS births in the state are to mothers on TennCare. The agency now spends $50 million a year on the related hospital bills as infants go through detox in a neonatal intensive care unit.
To make sure mothers don't end up having a second child with the same condition, TennCare is prodding obstetricians to recommend birth control implants, which are reversible but are effective for years.
“We want to put in place the right incentives for that conversation to occur,” chief medical officer Vaughn Frigon says.“That’s really a conversation that’s best between the treating physician and the mother. But what we want to do is make sure that those contraceptives are available.”
TennCare has tweaked reimbursements so doctors can get paid more for the procedure if its done while a new mother is still in the hospital. The agency has also made it easier for hospitals to keep the implants or intrauterine devices (IUD) on hand.
The latest TennCare data shows fewer women on prescribed painkillers taking birth control pills too. Among 30 to 34-year-olds, just 15 percent of those on prescribed opiates also were on contraceptives.
Women’s health groups are somewhat wary. Health officials have also been pushing birth control as women leave jail in some counties with particularly high instances of neonatal abstinence syndrome.
“There’s definitely another concern around is it being done in a coercive way? Are they giving and receiving proper consent?” asks Allison Glass of Healthy and Free Tennessee. "We absolutely do support expanded access to health services, but we do have concerns if its only being targeted at babies being born showing signs of NAS."
Still, Glass says "almost anything is better" than the punitive approach taken by state lawmakers. A statute up for renewal this year, which has gained national attention, can make giving birth to a drug-dependent baby a misdemeanor offense.