University of Chicago, Chicago, IL, United States.
Ibis Reproductive Health, Cambridge, MA, United States.
Contraception. 2021 Jun;103(6):414-419. doi: 10.1016/j.contraception.2021.02.008. Epub 2021 Feb 19.
On January 1, 2018, Illinois became the first Midwestern state to cover abortion care for Medicaid enrollees. This study describes state implementation of the policy, the impact on abortion providers, and lessons learned.
We documented abortion providers' perspectives on the service delivery consequences of Medicaid coverage for abortion in Illinois. We conducted in-depth interviews with clinicians and administrators (N = 23) from 15 Illinois clinics, including clinics that provided other services and those primarily providing abortion. We conducted interviews in person or by phone between April and October 2019. They lasted ≤100 minutes, were audio-recorded, transcribed, and coded in Dedoose. We developed code summaries to identify salient themes across interviews.
All participants supported the law and expected benefits to patients. Many struggled to implement the policy because of difficulties obtaining certification to bill the state Medicaid program, confusing and cumbersome paperwork requirements, reimbursement delays, confusing claim denials, and uncertain protocols for Medicaid patients covered under the exceptions defined by the Hyde Amendment. Nearly all participants expressed concern that low reimbursement rates were insufficient to cover costs. Implementation was easier for multiservice clinics and those nested in larger institutions. Several clinics closed during implementation; one clinic opened. Clinics leveraged internal resources, external funding, and technical assistance to ensure that Medicaid enrollees could receive care without costs.
Implementing Medicaid coverage for abortion requires proactive and responsive state institutions, improvements to reimbursement processes, and adequate reimbursement rates. In Illinois, successful implementation depended on clinic adaptability, external support, and advocacy.
Our research suggests that successful, sustainable implementation of Medicaid coverage for abortion depends on state policies that allow clinics to enroll patients, process claims in 30 to 90 days, and receive reimbursements covering the cost of care. Without these measures, ensuring immediate patient access may depend upon clinics mobilizing resources and external transitional support.
2018 年 1 月 1 日，伊利诺伊州成为第一个为医疗补助计划参保人提供堕胎护理的中西部州。本研究描述了该政策的州级实施情况、对堕胎提供者的影响以及所吸取的经验教训。
我们记录了堕胎提供者对伊利诺伊州医疗补助计划涵盖堕胎服务的提供后果的看法。我们对 15 家伊利诺伊州诊所的临床医生和管理人员（N=23）进行了深入访谈，这些诊所包括提供其他服务和主要提供堕胎服务的诊所。我们于 2019 年 4 月至 10 月期间通过面谈或电话进行了访谈。访谈时长不超过 100 分钟，访谈内容被录音、转录，并在 Dedoose 中进行了编码。我们编写了代码摘要，以确定访谈中突出的主题。
所有参与者都支持该法律，并期望为患者带来益处。许多人在实施该政策时遇到了困难，因为难以获得向州医疗补助计划开具账单的认证，文书工作要求复杂且繁琐，报销延迟，报销申请被拒令人困惑，以及在遵守海格修正案规定的例外情况下为医疗补助计划参保人制定的协议不确定。几乎所有参与者都表示担心低报销率不足以覆盖成本。多服务诊所和那些嵌套在更大机构中的诊所实施起来更容易。在实施过程中，有几家诊所关闭，一家诊所开业。诊所利用内部资源、外部资金和技术援助，确保 Medicaid 参保人能够在不产生费用的情况下获得护理。
实施医疗补助计划涵盖堕胎需要积极主动和响应迅速的州机构、改进报销流程和充足的报销率。在伊利诺伊州，成功实施取决于诊所的适应性、外部支持和倡导。
我们的研究表明，医疗补助计划涵盖堕胎的成功和可持续实施取决于州政策，这些政策允许诊所为患者注册、在 30 至 90 天内处理报销申请，并获得涵盖护理成本的报销。如果没有这些措施，确保患者立即获得服务可能取决于诊所调动资源和外部过渡性支持。
