Providers do not always receive Medicaid reimbursement for abortions that qualify for federal funding, according to "Medicaid Funding for Abortion: Providers’ Experiences with Cases Involving Rape, Incest and Life Endangerment," by Deborah Kacanek et al., of Ibis Reproductive Health. The article is currently available online and will appear in the June 2010 issue of Perspectives on Sexual and Reproductive Health.

The Hyde Amendment, first enacted in 1976, bans federal funding for abortions in the United States except in cases where the pregnancy resulted from rape or incest or endangers the life of the woman. Yet even in cases that meet those criteria, Kacanek and her coauthors find that many providers are not able to overcome the administrative hurdles necessary to access that funding. And if they do, the expense of staff time required, combined with the low level of reimbursement, dissuades them from trying to seek funding in the future.

Kacanek and her coauthors conducted in-depth interviews with representatives of 25 abortion providers in six states, all of which limit Medicaid funding to the restrictions imposed by the Hyde Amendment. They found that of the 245 reported abortions that should have qualified for Medicaid reimbursement in the past year, 143 were not reimbursed. Of those that were reimbursed, 97% were in one state. Respondents reported that administrative burdens, including excessive staff time, bureaucratic claims procedures and ill-informed Medicaid staff, all hampered their efforts to seek reimbursement. As a result, providers found alternatives to working with the Medicaid system, including offering discounted services to their patients, providing loans or absorbing the costs of abortions themselves. Additionally, many providers relied on nonprofit abortion funds to cover the costs of the procedures. However, respondents recognized that while these funds are reliable, they cannot cover all of the women seeking services.

The authors conclude that policies governing federal funding of abortion are inconsistently implemented. They suggest a need for interventions to help the system to better meet the needs of poor women, and to avoid pushing the financial responsibility onto others, including providers. Ideas for such interventions include streamlining forms and administrative processes, educating Medicaid staff and providers about qualifying cases, screening regularly for rape, and reducing the burdensome and complex requirements for proving instances of rape. Additionally, they call for interventions to ensure that Medicaid reimburses qualifying cases in accordance with federal law.