Study shows Medicaid system not meeting needs of women seeking abortion services

April 2010

April 7, 2010 – The Medicaid system is not meeting the needs of women seeking abortion services, even in cases that qualify for federal funding under the current Hyde Amendment restrictions. This is the main finding from the article “Medicaid Funding for Abortion: Providers’ Experiences with Cases Involving Rape, Incest and Life Endangerment,” by Deborah Kacanek, Amanda Dennis, Kate Miller, and Kelly Blanchard of Ibis Reproductive Health. The article is currently available online and will appear in the June 2010 issue of Perspectives on Sexual and Reproductive Health.

The Hyde Amendment, first enacted in 1976, bans federal funding for abortions in the United States except in cases where the pregnancy resulted from rape or incest or endangers the life of the woman. Ibis Reproductive Health interviewed abortion providers about their experiences working with Medicaid to obtain coverage for abortions in these limited cases in order to examine the impact of restrictive funding polices on low-income women. Researchers conducted in-depth interviews with representatives of 25 abortion providers in six states that limit Medicaid funding to the restrictions imposed by the Hyde Amendment (FL, ID, KS, KY, PA, WY). They found that of the 245 reported abortions that should have qualified for Medicaid reimbursement in the year prior to their interview, only 102—less than half—were actually covered—and 97% of those were in one state.

Respondents reported that administrative burdens, including excessive staff time needed to manage claims, cumbersome claims procedures, and ill-informed Medicaid staff, hampered their efforts to seek reimbursement. Bureaucratic Medicaid policies and procedures led to delays for women in obtaining abortions and also meant women had to delay treatment for life-threatening conditions such as cancer and HIV. In addition, some women were prevented from obtaining abortions. Because of the excessive burden of applying for Medicaid reimbursement in these limited cases, many providers said they have “given up” on working with Medicaid.

Under the new US health care reform law, even more women—including those newly eligible for Medicaid, as well as those who purchase health plans with federal subsidies—may be denied access to abortion care. “The Medicaid system is broken. If women who fall under the ‘exceptional’ cases cannot get Medicaid to pay for their abortions now, the problem will only get worse as more women are affected by restrictions in the new health care system,” said Kelly Blanchard, president of Ibis Reproductive Health.

When Medicaid funding was not available, even in cases that by law should have been covered, women often had to put off paying their bills, sell their belongings, or borrow money from friends and relatives. Providers sometimes offered discounts to women or absorbed the full or partial costs of abortions. Both women and providers turned to abortion funds, local nonprofits which raise money from community members to help individual women cover the costs associated with an abortion. Providers said the abortion funds are a “lifesaver” for many women in need. 

“In order to ensure that all women, regardless of income or insurance status, have equitable and timely access to abortion services, we must overturn the Hyde Amendment. But in the meantime, steps must be taken to make sure Medicaid pays for abortions in cases that should be covered under current law,” said Blanchard.

Ibis Reproductive Health has developed a body of work that examines the impact of restrictive federal funding policies on US women. Our interviews with abortion providers in other states corroborate our finding that women are mostly unable to access federal Medicaid funding for abortion in qualifying cases. We are currently conducting research in states that use their own funds to pay for abortions for women covered by Medicaid and are also examining barriers to abortion and reproductive health care access for women in the military.

This article, which will be published in the June issue of Perspectives, is now available to subscribers through the Early View feature. For more information about Ibis’s body of work on abortion funding restrictions, please visit our project description