Evidence meets action: Strategies to ensure Medicaid covers abortion care in qualifying cases

Background: Federal policy states that Medicaid coverage should be available for abortion in cases of rape, incest, and life endangerment. Some states also use state funds to provide Medicaid coverage of abortion in broader circumstances. However, data shows that women are largely unable to access this coverage and that attempts to secure coverage create service delivery challenges for abortion providers.

Purpose: To outline evidence-based strategies that providers, advocates, policymakers and women can take on to ensure state Medicaid programs cover abortion as outlined by state and federal policy.

Methods: Analysis of interviews with 71 low-income women who have had abortions and 69 abortion providers representing 70 practices in 15 states, building on a desk review of previous advocacy efforts, allowed us to identify challenges working with Medicaid and strategies for reforming Medicaid.

Results: Our research shows that there are a number of policy, advocacy, and practice-based strategies that stakeholders can implement to mitigate the challenges women and abortion providers face when working with Medicaid. Strategies were both newly generated and previously implemented by interviewees; strategies included educating a broad array of stakeholders about current policy, streamlining Medicaid enrollment processes, influencing internal Medicaid protocols regarding abortion coverage and reimbursement, implementing case management strategies to help women secure Medicaid-covered care, and calling for broad policy change in Medicaid's handling of coverage and reimbursement for abortion care. Conclusion: With increasing threats to abortion care, evidence-based strategies to protect abortion access must be identified, tested, and shared to protect women's health and human rights.