Prohibition of preventive health care: an analysis of Medicaid non-reimbursement for indigent women.

This paper presents a policy analysis of the impact of prohibiting Medicaid reimbursement funding for tubal ligations by indigent women, under 21 years of age. Because this population is dependent upon Medicaid funds, the freedom of self determination is limited. The current policy does not provide any alternative to the age rule, even if the patient is infected with a life-threatening disease, such as human immunodeficiency virus (HIV). The policy, therefore, creates serious problems for those individuals who choose to prevent a pregnancy under certain life-threatening circumstances. As the incidence of AIDS continues to increase, the absence of an age alternative for tubal ligations will become a problem of increasing practical and statistical significance. The conceptual framework for the analysis of Medicaid nonreimbursement for tubal ligations, with respect to age demands was adopted from the work of Gilbert and Specht, 1986. Four dimensions of choice are addressed: (1) the bases of social allocation, (2) the nature/type of social provisions, (3) the delivery system and (4) finances. Although all areas will be addressed, the major emphasis will be placed on social allocation.