Many States Don't Comply With Even Limited Requirements Around Medicaid and Medication Abortion

A recent report by federal investigators at the nonpartisan Government Accountability Office found that federal officials are not uniformly enforcing a requirement that certain (and very limited) abortions be covered through Medicaid.

According to the study, 13 states do not cover the drug Mifeprex, which induces abortion, when an abortion is available under Medicaid. South Dakota reportedly hasn’t complied with this particular healthcare rule for the past 25 years. A recent study from ThinkProgress also documents many states’ woeful lack of compliance and other ways in which coverage is further circumscribed, such as the requirement in some states that the pregnant person provide evidence of rape or incest in order to obtain an abortion through Medicaid.

Though the Hyde Amendment generally blocks federal funding for abortions, one exception to that rule are state Medicaid programs, which are required to cover the cost of an abortion when the pregnancy is a result of rape or incest, or when it threatens the life of the pregnant person. Here is the New York Times’ more nuanced explanation of why abortion medication is sometimes supposed to be covered by Medicaid:

“Federal law does not explicitly require Medicaid coverage of the prescription drugs used to terminate a pregnancy. But states are generally required to cover the drugs of any companies that agree to give deep discounts to Medicaid through its drug rebate program, and the manufacturer of Mifeprex, Danco Laboratories, is among those companies. So states are supposed to cover the drug when it is used in abortions eligible for federal funding under the Hyde Amendment.”

The Times reported that Diana DeGette, a Democratic representative from Colorado, who asked for the investigation to be done, was disappointed by the report’s findings:

“States are supposed to be covering a limited number of abortions under Medicaid, but are not even doing that. A poor woman who has been raped or raped by a relative or whose life might be endangered by carrying a pregnancy cannot afford to go to another state to get these services. That’s why we have Medicaid covering services like this.”

The report also found that the Trump administration, following in the footsteps of its predecessors, has yet to substantively address noncompliance. Federal officials’ lame excuse for not covering the drug is that they “were not aware that these states did not cover Mifeprex, and thus the agency had not sought to address states’ noncompliance.” The Trump administration responded to seeing a draft of the report by saying it would encourage states to comply “in accordance with federal laws and guidance.”