One of the persistent misrepresentations raised in the debate to repeal the Affordable Care Act (ACA) involves Medicaid funding of abortion. The simple fact is, since the passage of the Hyde Amendment in 1976, there is no federal Medicaid funding of abortion, except in three narrowly defined situations: if continuing the pregnancy would endanger the life of the woman, or the pregnancy resulted from rape or incest.
What this means is that under current law a woman cannot use her Medicaid coverage to pay for an abortion; a provider cannot bill Medicaid for abortion services and Medicaid cannot reimburse a provider for abortion services, except for the three narrowly defined situations described above.
I am intimately familiar with the rigorous accounting for and audits of federal Medicaid spending. Medicaid pays only for eligible covered healthcare services and ensures, through claim reviews and post-payment audits, that only qualified services that are actually provided as claimed are reimbursed.
In other words, Medicaid does not provide block grants to providers. It reimburses based services provided. Each eligible covered healthcare service is reimbursed if it meets the rules; and reimbursed based on an agreed upon fee structure.
Since abortion is not a covered service (except where the mother’s life is endangered or rape or incest), there is no federal reimbursement.
This works the same way for all providers who bill Medicaid, whether a hospital, a private doctor, community health center or a Planned Parenthood health center.
In addition to the routine claim review process, Medicaid and healthcare providers are subject to audits and claims reviews by both state and federal auditors. Furthermore, the Centers of Medicaid and Medicare Services (CMS) operates many program integrity initiatives designed to ensure the proper financial management of the program, to assess whether there are erroneous payments and to identify fraud and abuse. In the case of abortion services, because of the strict federal ban, oversight of this area is particularly rigorous.
I’ll say it again: federal Medicaid funds don’t go towards abortion services, except under the very limiting authorization of the Hyde amendment. And the reimbursement restrictions are enforced by a comprehensive claims process, multiple levels of review, rigorous accounting, and state and federal audits. Moreover, seeking reimbursement for a service that is not covered under Medicaid could subject the offending provider to recovery of the improper payments, as well as liability under the civil False Claims Act (FCA). Violations of the FCA can cost a healthcare provider millions of dollars, as well as other significant administrative sanctions.
Medicaid plays a vital role in providing care to women. According to the Kaiser Family Foundation, 1 in 5 women of reproductive age rely on Medicaid for preventive care. As Kaiser outs it, Medicaid is also the “largest payer of maternity care and publicly funded family planning.” It is important that policymakers have accurate facts when it comes to Medicaid.
In my experience, the federal healthcare system (including individual healthcare providers and hospital providers, as well as state and federal Medicaid administrators and auditors), takes compliance with the prohibition against federal funding of abortion services very seriously. To suggest otherwise does a disservice to an informed debate about healthcare reform.
Lewis Morris served in the Department of Health and Human Services, Office of Inspector General (OIG) for 25 years, including 10 years as Chief Counsel to OIG, before moving to private practice in 2012. Morris is currently an attorney with Hall Render Killian Heath & Lyman.
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