Medicaid & Out of State Abortions Confusion Reigns
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Universal Healthcare News
Last week, Baltimore, Maryland became the latest city in the United States to pass a resolution in support of Medicare for All!
Our allies at Public Citizen led this effort through their Medicare for All Resolutions campaign. Thanks to their organizing, they’ve helped more than 100 cities and towns across the country take this step toward building the political will and pressure needed to achieve guaranteed health care for all.
Despite this win being years in the making, this was a simple process: a resolution was set for a hearing at the onset of the pandemic in 2020, and a city council shakeup shortly after that put it on the back burner. But when activists reached out to a council member, she agreed to revive the resolution along with the original council sponsor, and it passed!
If you’d like to get your city/town to pass such a resolution here is a link to where you can learn how to do it. https://www.medicare4allresolutions.org/.
Abortion Confusion
I am reprinting an article about the confusion that exists post Dobbs. It is from the Journal pf the American Medical Association. It demonstrates the confusion the Supreme has inflicted on we the people instead of clarifying the situation
Mystery Shopper Study of State Medicaid Coverage for Out-of-State Abortion Care by
Hazar Khidir, MD, MHS; Carlisle Topping, BA; Vanessa K. Dalton, MD, MPH; et al
Introduction
The Supreme Court Dobbs v Jackson Women’s Health Organization decision has exacerbated state-level variability in abortion access. Some pregnant people have turned to abortion care out of state.
Approximately 35% of people seeking abortion care rely on Medicaid.2 The Hyde Amendment prohibits use of federal funds for abortion except in cases of life endangerment, rape, or incest, although some states use state funding to cover in-state abortions beyond these exceptions. Federal regulation requires state Medicaid plans to cover out-of-state services in medical emergencies.5 Little is known about whether state Medicaid agencies cover abortion care obtained out of state. This cross-sectional study used a mystery shopper survey to examine variation in state Medicaid agency responses to coverage questions on out-of-state abortion care.
Methods
The Yale University institutional review board deemed this cross-sectional study nonhuman participants research, so informed consent was not required. The STROBE reporting guideline was followed.
Between August 22 and September 9, 2022, 3 female callers surveyed Medicaid agencies in all 50 states and the District of Columbia using a mystery shopper design. Using a standardized script, callers stated they were calling on behalf of an adult beneficiary seeking out-of-state abortion care. Callers asked about out-of-state abortion coverage in general and in a medical emergency. Callers did not inquire about coverage for other exceptions but documented when they were mentioned by representatives. Callers spoke with the first available representative. A standard form was used to document responses and descriptive statistics to summarize responses. A summary of in-state abortion laws and Medicaid abortion coverage policies is provided in the Table in Supplement 1.
Results
A total of 122 calls were made to 51 agencies; 40 (78%) responded to questions about coverage for out-of-state abortion, 7 (14%) were unreachable, and 4 (8%) could not be surveyed. Of 40 representatives surveyed, 4 (10%) did not know if out-of-state abortion was covered, 4 (10%) said out-of-state abortion was not covered in a medical emergency, 32 (80%) said out-of-state abortion for a medical emergency would be covered; of these, 8 indicated it was also covered in other circumstances (Table 1).
Of 32 representatives reporting coverage for medical emergencies, 20 defined medical emergency as a life-threatening circumstance (Table 2). Representatives indicated that a variety of entities decided whether the definition of a medical emergency was met. Twelve representatives said out-of-state abortion may require prior authorization. Only 9 representatives responded with certainty that both medical and surgical abortion care would be covered.
Discussion
We found variability in agency staff representation of coverage policies for out-of-state abortion care. Some representatives provided information inconsistent with federal policy (eg, state Medicaid agency representatives indicated that Medicaid would not cover out-of-state abortion in a medical emergency). Two of these states, Mississippi and Louisiana, had near-total abortion bans in effect at time of data collection. Most representatives (80%) told callers that abortion care rendered out-of-state would be covered only in a medical emergency. This highlights the need for states to establish Medicaid waivers for pregnant people traveling across state lines to seek abortion care.6
Even in a medical emergency, coverage barriers exist, primarily lack of a consistent, pragmatic definition of medical emergency that can be implemented in real time. Most agencies defined medical emergency as “life endangerment.” Yet, agencies commonly indicated that determination of life endangerment was made retrospectively by various entities, some without expertise in emergency care. Furthermore, some states required emergency physicians to submit prior authorization. Delayed or retrospective application of a life-endangerment standard threatens the lives and livelihoods of pregnant people and creates legal risk and moral distress for clinicians. Federal policy should establish common administrative requirements for out-of-state abortion coverage and monitor states’ abortion claims decisions to ensure adherence to federal regulations. Our study was limited in that findings were based on 1 round of calls to each state agency, so we could not assess for consistency in coverage information within states.
ACTION
The legal and healthcare status of women is abysmal. 24 states treat women as 2nd class citizens without bodily autonomy. Enough already. Let’s let our representatives know we want them to pass the Women’s Health Protection Act to restore the right to an abortion nationwide. While they are thinking about it they can just make women full citizens and remove the Equal Rights Amendment deadline. Phone and email POCs are in the Resources section. You can use RESISTBOT by texting to 50409 SIGN PTRHSG to send the email below.
“I am your constituent and I just learned from a study published in the Journal of the American Medical Association that when state Medicaid agencies were asked whether Medicaid would cover an emergency abortion out of state, the agencies responses varied dramatically. Many wanted prior authorization for a life threatening emergency. That will kill women. Many also did not know what constitutes a life threatening emergency. ALL OF THIS PUTS WOMEN’S LIVES AT RISK.
I know you don’t want women suffering and even dying needlessly so I want you to fix this. I want you to PASS the WOMEN’S HEALTH PROTECTION ACT to restore the right to have an abortion nationwide.
While I have your attention let’s remove the deadline for the Equal Rights Amendment and let that be law so women have full rights. Thank you.”
EXTRA CREDIT ACTION
Let’s send a note of thanks to Mayor Brandon Scott of Baltimore for passing a resolution in support of Universal Healthcare. Here is his contact link.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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