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Abortion

Documenting the impact of the Hyde Amendment on women’s abortion access

In 1976, Congress passed the federal Hyde Amendment, which prohibits the use of federal Medicaid funding for abortions except for women whose pregnancies are due to rape or incest, or are life endangering. Currently, 32 state Medicaid programs and the District of Columbia fund abortions only in these cases, and in South Dakota public funding only covers abortions in cases of life endangerment. Anecdotal and circumstantial evidence suggests that even in these cases it is difficult, if not impossible, to access Medicaid funding to cover abortions, despite the fact that these conditions are exempted from the Hyde Amendment ban on federal abortion funding and coverage is legally mandated.

Ibis conducts a program of research examining federal and state Medicaid coverage of abortion in the US, using qualitative and quantitative methods. In the first two phases, conducted from October 2007 – March 2009, Ibis interviewed abortion providers in ten states that follow the federal funding guidelines to investigate their experiences seeking Medicaid reimbursement for abortions in the limited cases outlined by the Hyde Amendment (FL, IA, ID, KS, KY, ME, PA, RI, WI, WY) and in one state where state Medicaid funding is supposed to be available in all or most cases (IL). We sought to determine how frequently providers have been able to successfully obtain Medicaid funds to cover termination costs, and to document their experiences, challenges, and successes with attempting to obtain Medicaid coverage for abortion. Through almost 50 in-depth interviews, we identified several systemic barriers to obtaining Medicaid funding for abortions. Most providers reported that even in the limited cases allowed under the Hyde Amendment, women are unable to get obtain coverage by Medicaid for qualifying abortions. Many providers have stopped seeking funding from Medicaid altogether and instead women themselves, abortion providers, and abortion funds cover the cost of procedures. Further, when providers succeed in obtaining funding, reimbursement rates are low and the process requires excessive staff time. We were also able to document best practices for securing Medicaid funding based on the experiences of a small number of providers who had some success working with Medicaid, though these successes were often hard won.

In March 2010, we completed data collection for the third phase of our research on abortion providers’ experiences accessing Medicaid funding. We interviewed providers in Arizona, Maryland, New York, and Oregon, states where the law allows for the use of state funds to cover all or most abortions. Analysis of these interviews is currently underway.

As a fourth phase, we have launched a “mystery caller” study of state Medicaid offices. In the 15 states where we have conducted interviews with providers, we will call Medicaid offices and solicit information from staff about the circumstances under which abortion is covered in the state and the process for obtaining coverage.

In response to advocates’ requests, we have completed state-specific analyses of our research data. We are reaching out to advocates to get feedback on how to use and disseminate the analyses. If you are a provider or an advocate working in one of the 15 states where we’ve conducted interviews and are interested in learning more about the state analyses we’ve completed, please contact Amanda Dennis. We also plan to convene advocates in 2010 to determine strategies for using our research to advocate for improvements in Medicaid funding for abortion.


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