Contextualizing Medicaid reimbursement rates for abortion procedures

Area of Science:

• Healthcare Economics
• Reproductive Health Policy
• Health Services Research

Background:

• Low Medicaid reimbursement rates pose a significant challenge to abortion clinic financial sustainability in the U.S.
• Understanding reimbursement disparities is crucial for ensuring access to reproductive healthcare services.

Purpose of the Study:

• To compare Medicaid and Medicare fee-for-service (FFS) reimbursement rates for abortion and miscarriage management procedures.
• To analyze the adequacy of Medicaid reimbursement in covering patient costs for these procedures.

Main Methods:

• Utilized 2017 Medicaid and Medicare Physician fee schedules from 45 states and the District of Columbia.
• Extracted and compared reimbursement data for two common abortion procedures and two miscarriage management procedures.

Main Results:

• Medicaid reimbursement rates for abortion procedures varied widely by state, with second-trimester abortions showing the largest range ($79-$626).
• Median Medicaid rates were lower than median Medicare rates for both first- and second-trimester abortions.
• Medicaid reimbursement covered only 37% and 41% of patient costs for first- and second-trimester abortions, respectively.

Conclusions:

• Medicaid reimbursement rates for abortion are substantially lower than both Medicare rates and actual patient costs.
• Discrepancies in reimbursement between abortion and miscarriage management procedures, despite clinical similarities, warrant attention.
• Aligning reimbursement with procedural costs is vital for provider acceptance of Medicaid and ensuring patient access to care.