OBJECTIVE: To assess the importance of Pennsylvania Medicaid immediate postpartum long-acting reversible contraception (IPLARC) reimbursement policy changes for hospital implementation of IPLARC by rurality. STUDY DESIGN: We surveyed clinician leaders at 51/82 (62.2%) Pennsylvania hospitals with L&D units in 2022, including 10/51 (19.6%) rural and 17/51 (33.3%) academic. RESULTS: Six years after Pennsylvania Medicaid began covering IPLARC outside the obstetrical care bundle, only 3/10 (30.0%) rural and 18/41 (43.9%) non-rural L&D units had implemented IPLARC. CONCLUSIONS: Fewer than half of delivering hospitals in Pennsylvania offered access to IPLARC, even after favorable Medicaid reimbursement policy changes. Non-rural hospitals are more likely to offer IPLARC than rural hospitals.