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After GAO Abortion Report, States Dispute Findings and Defend Violations

The report found 14 states to be in violation of federal Medicaid law as it pertains to abortion coverage.

A medical clinician speaks with a patient at a Planned Parenthood.
(AP/Steven Senne)


  • 14 states and the District of Columbia do not cover the abortion pill in cases of rape, incest and life endangerment, according to a recent GAO report.
  • The Centers for Medicare and Medicaid Services says it will work with states to make sure they comply with federal law.
  • Some of the states dispute the GAO findings, while others are defending their practices. 
Last month, the nonpartisan Government Accountability Office (GAO) reported that 14 states and the District of Columbia were in violation of federal Medicaid law as it pertains to abortion coverage. While some of those states dispute the GAO's report, others are defending their practices, and a couple are working to comply with the law. 

Federal money is generally prohibited from funding abortion services because of the 1976 Hyde Amendment. But in cases of rape, incest and life endangerment, Medicaid -- the nation's health insurance for the poor -- is supposed to cover any abortion services, including abortion pills.

According to the GAO, 14 states have denied coverage in these cases for the abortion pill, which is used until 10 weeks of pregnancy. One state -- South Dakota -- has been out of compliance with that law for more than 20 years, the GAO said.

South Dakota only covers the abortion pill for Medicaid patients if the woman’s life is in danger -- not for cases of rape or incest. State officials say they don’t have any plans to change that.

"South Dakota will continue to do what we always have done -- not cover abortion costs under Medicaid," Republican Gov. Kristi Noem’s office said in a statement, according to the Argus-Leader.

Governing reached out to the other 14 jurisdictions named in the report to see how they're reacting to the findings. Nine responded. Alabama, Arkansas, Kentucky, Missouri and South Carolina did not. 

Like South Dakota, Oklahoma’s Medicaid office says it has no plans to change coverage. Idaho and D.C., however, say they are currently working to comply with the law.

"In order to make the coverage effective, we must price the drug and update our claims payment system to allow reimbursement for Mifeprex [the abortion pill]. The Department of Health Care Finance is in the process of making these changes and expects to have Mifeprex covered and reimbursable within a month," says a spokesperson for D.C's Department of Health Care Finance.

Colorado, North Carolina and Rhode Island spokespersons say they believe their offices are already in compliance. Rhode Island officials even submitted a clarification letter to the GAO after the report was released.

The GAO acknowledges that federal data on the number of abortions eligible for Medicaid coverage is incomplete, which "limits the [Center for Medicare and Medicaid Services'] ability to ensure proper payments and states’ coverage of such abortions." 

Meanwhile, Florida and Texas say they only restrict coverage as it applies to pharmacies -- not for medication abortion services given to a patient in a medical office. According to the GAO report, the pill is prohibited from being dispensed in retail pharmacies -- but not hospital pharmacies. Utah, in contrast, restricts it on the medical side but not in a pharmacy setting. 

Advocates of abortion rights say the GAO report serves as confirmation that existing laws are not being properly enforced. 

“We knew anecdotally it was hard to get coverage -- at least now we have something documented saying states are violating Medicaid law,” says Fabiola Carrion, senior staff attorney for the National Health Law Program, which advocates for quality health care for low-income patients.

Enforcement of this law is up to the Centers for Medicare and Medicaid Services (CMS). In an email to Governing, a CMS spokesperson said that the agency will work with states moving forward and will "again notify states not in compliance with the coverage and expenditure reporting requirements examined in this report and urge their compliance."

Mattie covers all things health for Governing.

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