Medicaid's role in alleviating some of the financial burden of abortion: Findings from the 2021-2022 Abortion Patient Survey

Background: Medicaid is the most common type of health insurance held by abortion patients, but the Hyde amendment prohibits the use of Medicaid to pay for this care. Seventeen states allow state Medicaid funds to cover abortion. Methods: We used data from a national sample of 6698 people accessing abortions at 56 facilities across the United States between June 2021 and July 2022. We compare patient characteristics and issues related to payment for the abortion across patients residing in states where state Medicaid funds covered abortion (Medicaid states) and those where it did not (Hyde states). We also examine which abortion patient populations were most likely to use Medicaid in states where it covers abortion care. Results: In Medicaid states, 62% of respondents used this method to pay for care while a majority of individuals in Hyde states, 82%, paid out of pocket. Some 71% of respondents in Medicaid states paid USD0 and this was substantially lower, 10%, in Hyde states. In Hyde states, two-thirds of respondents had to raise money for the abortion (e.g., by delaying bills) compared to 28% in Medicaid states. Within Medicaid states, groups most likely to rely on this method of payment included respondents who identified as Black (70%) or Latinx (66%), those in the lowest income group (78%) and those having second-trimester abortions (75%). Discussion: When state Medicaid funds cover abortion, it substantially reduces the financial burden of care. Moreover, it may increase access for groups historically marginalized within the health care system.