Impacts of funding restrictions on abortion access: Tennessee

Medicaid is a joint federal and state health insurance program in the United States for people who meet income eligibility criteria, i.e. households with incomes up to 138% of the federal poverty level. Medicaid coverage has been shown to improve health outcomes and reduce mortality; however, coverage varies state-tostate and restrictions on coverage have a disproportionate impact on those with limited financial means.

Women comprise over two-thirds of adult Medicaid enrollees, and approximately 67% of women on Medicaid are of reproductive age (15-44 years). Although Medicaid covers a wide range of reproductive health care services, including family planning, prenatal and postpartum care, and childbirth, coverage of abortion services is limited by the Hyde Amendment.

First passed in 1976, the Hyde Amendment prohibits federal funding for Medicaid coverage of abortion care except when a person’s* pregnancy results from rape or incest, or when it endangers the pregnant person’s life. The Hyde Amendment has been renewed annually as a rider to the Labor, Health and Human Services, Education, and related Agencies (Labor-H) appropriations legislation. States may elect to use their own funds to cover abortion care for pregnant people with Medicaid under broader circumstances; however, as of January 2020, only 16 states have opted to use their own state funds to cover abortion in most cases, while 34 states and the District of Columbia follow the federal Hyde prohibitions.

In 2014, three-fourths of all women who had an abortion in the United States were low income, one-half of whom were living under the federal poverty line and eligible for Medicaid coverage.

Yet Medicaid accounted for just 24% of payments for abortion care that year, with many patients having to pay out-of-pocket. Research in a similarly restrictive Southern state found that Medicaid funding restrictions may lead to 29% of pregnant women who meet criteria for Medicaid continuing a pregnancy rather than obtaining an abortion. For pregnant people who are able to obtain an abortion, these funding restrictions may delay wanted care or force them to forgo needed household expenses, such as groceries or rent, in order to pay out-of-pocket for care.