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Medicaid Coverage for Abortion Care Elusive Even in States Where It Is Legal

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Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new abortion research that activists may not otherwise be able to access.

Passed in 1976, the Hyde Amendment prohibits federal Medicaid funding for abortion procedures. Under Hyde, a person with Medicaid as their health insurance can only use their insurance to cover the cost of an abortion if the pregnancy is the result of rape or incest, or the pregnancy endangers that person's life. While Hyde has placed these deplorable restrictions on abortion coverage for almost 40 years, some states have attempted to correct this injustice -- 17 states use their own funds voluntarily to cover abortion. While advocates fight to repeal Hyde and restore federal funding for abortion through Medicaid, we assume that abortion access in the 17 "Hyde-free" states is much more equitable than in the 34 states that do not provide such coverage. But are people in states with voluntary Medicaid coverage of abortion actually able to use Medicaid to pay for an abortion? Do they have insurance coverage of abortion both in theory and in practice?

Two new research briefs from Ibis Reproductive Health document the reality of Medicaid coverage of abortion in Arizona and Maryland, two  of the 17 states that use their own funds to pay for abortions. Arizona is court-ordered to provide states funds to cover "medically necessary" abortions, while Maryland offers voluntary Medicaid coverage regardless of the pregnancy circumstance. In an ideal world, these requirements would mean that individuals in Maryland and Arizona would have no trouble using their state Medicaid to pay for an abortion. As you can probably guess, this is a far cry from what's really happening in these states.

Ibis conducted in-depth interviews with abortion providers in Maryland to gauge their experiences seeking Medicaid coverage for their patients' abortions. These providers explained that while their state Medicaid theoretically covers abortion regardless of the circumstances, in practice, it rarely covered abortion at all. Providers reported insurmountable challenges engaging with the Medicaid office. For example, Medicaid staff did not know when and if abortions qualify for coverage, the complicated billing process through Medicaid was confusing and time-consuming, and Medicaid did not reimburse for providing abortions that should have been covered. These barriers sometimes led providers to stop working with Medicaid altogether. This systemic level incompetence is unacceptable and obviously does not meet the needs of people seeking abortions and clinics providing that health care service. 

 

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