Advocates, health care providers, and women step forward to ensure US women can access Medicaid funding for abortion in cases of rape, incest, and life endangerment

September 30, 2011 – A combination of advocacy, legal, and grassroots strategies can help improve access to Medicaid coverage for US women who seek abortions in cases of rape, incest, or life endangerment, according to “Strategies for securing funding for abortion under the Hyde Amendment: A multistate study of abortion providers’ experiences managing Medicaid,” by researchers at Ibis Reproductive Health published online this month in the American Journal of Public Health.

Today is the 35th anniversary of the Hyde Amendment, which since 1976 has prevented women enrolled in the US Medicaid program from using their health insurance for abortion care in most circumstances. The policy currently stipulates that when a pregnancy results from rape or incest, or when it endangers a woman’s life, federal Medicaid coverage should be available. Most US states follow the federal example and restrict Medicaid coverage of abortion to the circumstances outlined by the Hyde Amendment.

But findings from almost 50 in-depth interviews with abortion providers in 11 states that restrict abortion coverage to only the cases permitted under the Hyde Amendment suggest that limiting the circumstances that qualify for coverage effectively leads to prohibitions on coverage in all cases. Despite the exceptions carved out by the Hyde Amendment, most abortion providers in states that restrict Medicaid coverage confront considerable difficulty obtaining reimbursements for abortions provided to women in cases of rape, incest, or life endangerment.

Only 37% of the 1,165 abortions provided in cases of rape, incest, or life endangerment included in Ibis’s research were ultimately covered by Medicaid. Consequently, women, abortion providers, and abortion funds covered the costs of 736 abortions that should have been paid for by Medicaid.

The few abortion providers who were successful at securing Medicaid coverage for women in these cases developed a number of strategies to overcome the systemic barriers to reimbursement. Developing relationships with Medicaid staff helped make the claims process easier and increased the number of qualifying abortions that were covered. Establishing strong and savvy billing departments also increased providers’ success working with Medicaid. Some providers found that Medicaid was more responsive when women themselves contacted Medicaid to advocate for coverage of their cases, but providers worried that women struggling to cope after a rape or with a severe illness might feel overwhelmed and further victimized by the process of negotiating with Medicaid.

Broad-based, state-level interventions appeared to hold the most promise for increasing women’s access to Medicaid coverage. The collaborative efforts of advocates, abortion providers, and legal experts in some states led to significant improvements on the ground, as well as at the policy level. In one state, a group came together to implement an effective statewide program of activities that included simplifying Medicaid claims forms and creating educational materials that explain when Medicaid should cover abortion care. These activities built on a legal victory that removed burdensome requirements that women submit paperwork “proving” the circumstances of their abortions (such as a police report in cases of rape).

“Ibis’s research has shown that in states where abortion coverage is limited to the Hyde Amendment exceptions, it is extremely challenging for providers to get reimbursed. Medicaid is a critical source of health insurance for millions of American women, but federal and state restrictions on abortion coverage are unjust, and make it very difficult for women to access the abortion care they need,” said principal investigator Kelly Blanchard, president of Ibis.

“As we mark the 35th anniversary of the Hyde Amendment, this study provides important insight into why the policy must be overturned. At the same time, it shows that while we work to repeal restrictions on abortion coverage, there are many things we can do to remove some of the obstacles that women are facing right now.” 

Ibis has conducted several studies evaluating the impact of Medicaid restrictions on US abortion providers and women. We will soon release resources summarizing our findings and ways that advocates, women, abortion providers, and policymakers can take action individually and collectively to improve women’s access to abortion care. For more information, please contact Amanda Dennis.