Abortion Care and Medicaid Policy In Illinois

Illinois House Bill 40 (HB 40) went into effect January 1, 2018, enabling for the first time in decades, Illinois state funds to be used to cover abortion services for Medicaid eligible persons without restriction. In order to understand abortion-providing facilities’ perceptions of Medicaid, HB 40, and the implementation of post-HB 40 Medicaid billing systems, staff representing 83% of abortion-providing facilities in Illinois were interviewed approximately one year after HB 40 went into effect, and their responses were thematically analyzed, with themes generated both deductively from the Consolidated Framework of Implementation Research, and inductively from the data. The main barrier to becoming a Medicaid provider for abortion-providing clinics was the universal perception that Medicaid’s reimbursement rate for abortion services was too low for clinics to be financially sustainable; clinics that chose to apply to become Medicaid providers did so because their mission of enabling access to abortion outweighed their financial concerns. Facilities that sought to become Medicaid providers after the passage of HB 40 described the application process as frustrating and lengthy. The primary facilitators of becoming a Medicaid provider within a year of beginning the application process were a particularly dedicated or experienced individual driving the application, the tangible and social support provided by an ACLU-convened workgroup, and privately donated funds that covered care for Medicaid-eligible patients for clinics in the Medicaid application process. Abortion-providing, Medicaid-accepting facilities also described factors that challenged or facilitated their ability to correctly bill Medicaid after HB 40. Regarding the impact of HB 40, respondents at most facilities perceived little change in patient load or staffing. Nearly every respondent extemporaneously spoke about the positive effect they had seen for their patients’ health and wellbeing. The administrative records of one Illinois facility were analyzed to identify whether covering abortion care affected the demographic characteristics or gestational age at termination for abortion patients from Illinois. Compared to previous years without coverage and patients from states without coverage, there was a shift in age and increased proportion of second trimester abortions with financial coverage.