Survey: Out-of-state abortion coverage responses vary from Medicaid representatives

Key takeaways:

• Of 40 surveyed Medicaid representatives, 80% said out-of-state abortion would be covered for a medical emergency.
• Nine representatives were certain that medical and surgical abortion care is covered by Medicaid.

U.S. Medicaid representatives had great variation in responses to questions regarding out-of-state abortion coverage, according to survey findings published in JAMA Network Open.

“The Hyde Amendment prohibits use of federal funds for abortion except in cases of life endangerment, rape or incest, although some states use state funding to cover in-state abortions beyond these exceptions,” Hazar Khidir, MD, of the National Clinician Scholars Program at Yale University School of Medicine, and colleagues wrote. “Federal regulation requires state Medicaid plans to cover out-of-state services in medical emergencies. Little is known about whether state Medicaid agencies cover abortion care obtained out of state.”

Khidir and colleagues conducted a cross-sectional study using a mystery shopper survey to evaluate variations in responses from state Medicaid agencies when inquiring about out-of-state abortion care coverage. From August to September 2022, three female callers surveyed Medicaid agencies in all 50 U.S. states and the District of Columbia. Using a standardized script, all callers stated that they were calling on behalf of an adult beneficiary seeking out-of-state abortion care and asked about out-of-state abortion coverage in general and for a medical emergency.

Overall, callers made 122 calls to 51 Medicaid agencies. Of these calls, 78% responded to coverage questions for out-of-state abortion, 14% were unreachable and 8% were unable to be surveyed. Of the 40 representatives surveyed, 10% did not know about out-of-state abortion coverage; 10% said out-of-state abortion was not covered in a medical emergency; 80% said it would be covered for a medical emergency, and eight of the representatives also indicated coverage for other circumstances.

Of the 32 representatives who reported medical emergency coverage, 20 defined a medical emergency as a life-saving circumstance and 12 noted that out-of-state abortion coverage may require prior authorization. Of all 32 representatives, nine responded with certainty that both medical and surgical abortion care is covered by state Medicaid.

“Delayed or retrospective application of a life-endangerment standard threatens the lives and livelihoods of pregnant people and creates legal risk and moral distress for clinicians,” the researchers wrote. “Federal policy should establish common administrative requirements for out-of-state abortion coverage and monitor states’ abortion claims decisions to ensure adherence to federal regulations.”