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Medicaid and the “heartbeat” law

Of interest.

Texas’ new abortion ban makes no exceptions for pregnancies that result from rape or incest. Nearly a month after it was enacted, state health officials still won’t say whether that includes Texans on Medicaid, a small but critical population that they are required to help access the procedure.

Under federal Medicaid rules, states are obligated to cover abortions in rare circumstances, including for victims of sexual abuse. The new Texas law prohibits abortions after six weeks of pregnancy and allows nearly anyone to sue those who defy the restrictions. It is at least temporarily in place while state and federal courts review whether it is constitutional.

The law appears to have forced the state Health and Human Services Commission into a predicament: either it flouts the state ban or it violates the longstanding federal guidelines.

The agency has not said how it is complying with either directive; a spokeswoman declined to comment, citing the pending litigation. In its Medicaid handbook, the agency still provides instructions for submitting abortion claims for reimbursement.

The Department of Justice pointed to the Medicaid impact in a lawsuit it filed earlier this month against the Texas ban. A hearing on that suit is scheduled for Friday.

“The statute arbitrarily denies Medicaid beneficiaries coverage of a procedure for which Medicaid coverage is mandatory,” lawyers for the department wrote in their complaint.

See here and here for some background on the DOJ lawsuit. The subject of Medicaid did come up in oral arguments on Friday, but it didn’t appear to be a main topic of interest. As this story notes, the main lever the federal government has to enforce this is to threaten to withhold Medicaid funding, but that would mostly hurt Medicaid recipients, and it is not at all clear that Greg Abbott would be inclined to give an inch. Some states like South Dakota have routinely violated this law, without consequence. Maybe it matters in this lawsuit and maybe it doesn’t, I don’t know. But there it is.

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