Perceptions and practice of state Medicaid officials regarding informed consent for female sterilization

Medicaid and Fulfillment of Postpartum Permanent Contraception Requests

“…9 We hypothesize that this is attributable to hospital-level factors such as institutional culture regarding the priority placed on urgency of permanent contraception surgery, workflow patterns to ensure that Medicaid sterilization forms are signed during antepartum care, and operating room availability. 20,24–26 However, the current findings suggest that Medicaid policy contributes to inequities in desired postpartum contraception fulfillment.…”

Obstetrician–Gynecologists' Practices in Postpartum Sterilization Without a Valid Medicaid Consent Form

“…Although the federal policy specifically states that loss of funding is for the procedure itself only, studies of state Medicaid officials corroborate the confusion on the part of ob-gyns given the variability in practice at the level of individual state Medicaid offices, with some states denying payment for the procedure itself whereas others deny payment for the entire pregnancy global fee and hospitalization. 18,19 Additionally, the possible legal repercussions of proceeding without a valid sterilization consent form are also unclear and could potentially range from insurance fraud to performing surgery without adequate consent. Increased education as well as transparency, clarity, and uniformity regarding the repercussions are important so that ob-gyns and institutions are able to offer comprehensive patient-centered contraceptive options without unnecessary barriers.…”

“…Prior studies have demonstrated a lack of clarity and consistency between states regarding the definition of the terms of "premature delivery" and "emergency abdominal surgery" both on the part of physicians and state Medicaid offices. 10,[18][19][20] Therefore, as long as the current form and waiting period remain standard, providing greater clarity on the conditions under which the waiting period can be shortened would allow for more consistent use and could potentially increase the number of desired sterilizations performed, because using them is in compliance with the federal policy.…”

Website Review of Variation in Individual State Medicaid Sterilization Policies

“…searched the website for each state's Medicaid office for publicly accessible policy elements regarding permanent contraception using the terms "sterilization, "sterilization policy," and "sterilization consent form" within the search engines of each website. 10,11 We analyzed pertinent similarities and differences in individual state policies from the standard federal guidelines (CFR Title 42, Subpart F "Sterilizations") and any available instructions and handouts for patients and physicians. We catalogued state policies in terms of specific policy details, number and types of changes made compared with the federal policy and sterilization consent form, logistical details such as timing of signatures and allowance of tele-interpreter signatures, flexibility in terms of changes in procedure or surgeon and whether corrections are permitted, and internal review processes.…”

“…2,8 Interstate variability in policy details and implementation has been reported previously. [8][9][10][11] However, a stateby-state policy analysis of information available to clinicians in each state has thus far not been presented. We therefore conducted a policy review of individual state Medicaid sterilization policies available on state websites to make this information available to clinicians.…”