State Medicaid Insurance Barriers to Vasectomy Coverage Are Associated With Restrictive Abortion Laws

To determine if state populations have equitable access to vasectomy under Medicaid and evaluate the relationship between accessibility of Medicaid-covered vasectomy and state abortion restrictions.

Individual state-based Medicaid rules were assessed by publicly available data for all 50 states and Washington, D.C. A novel scoring system quantifying restrictions to Medicaid coverage for vasectomy was developed utilizing state-specific Medicaid income eligibility criteria, presence or absence of extended family planning benefits, and any additional prohibitive vasectomy coverage policies (0-4 points; 0 no restrictions-4 most restrictions). Abortion access was quantified using the Guttmacher Institute's ranking of state abortion policy restrictions (1 most protective, 7 most restrictive). Fisher's exact test (α <.05) was used to evaluate the relationship between vasectomy access score and abortion access.

Fifty-one Medicaid regions (50 states and Washington, D.C.) were analyzed. For vasectomy access, each had a point assigned for a mandatory 30-day waiting period. Eighteen states (35%) had only 1 point assigned, 25 (49%) had 2, and 7 (14%) had 3 points. Texas was the only state to receive 4 points, correlating with the greatest number of barriers to vasectomy, due an additional consent form beyond the conventional paperwork. There was a statistically significant relationship between state Medicaid vasectomy coverage and restrictions on abortion access (P = .01). States with more barriers to Medicaid vasectomy coverage were more likely to have laws restricting abortion.

Access to vasectomy under Medicaid varies greatly by state. States with the most limited access to coverage also had the most restrictive abortion laws.