An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program

Executive Summary

An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (“Guide”) will familiarize readers with the basics of the Medicaid program and highlight features that support reproductive and sexual health. Since the Guide was first published in February 2010, the United States Congress passed and President Obama enacted the Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA). The ACA brought substantial changes to the Medicaid program and the entire health care system, including the modes of access to health coverage and the benefits that must be covered.

The Guide provides a brief overview of the Medicaid program, and explains the complex eligibility categories and requirements for the program with a focus on those categories that affect people seeking reproductive and sexual health care. The Guide also details the various reproductive and sexual health services available to Medicaid enrollees. The Guide also describes barriers and protections to accessing reproductive and sexual health services in Medicaid and other publicly funded reproductive and sexual health programs. Lastly, the Guide provides a brief overview of the administrative structure of and application process for the Medicaid program. Wherever possible, we also highlight best practices, policy recommendations, advocacy tips, and legal strategies to strengthen existing programs and address reproductive and sexual health disparities.

The entire guide can be downloaded or individual chapters accessed below.

Individual Chapters

Chapter I: Overview of the Medicaid Program
Chapter II: Medicaid Eligibility
Chapter III: Section 1115 Demonstration Waivers
Chapter IV: Reproductive and Sexual Health Services
Chapter V: Reproductive and Sexual Health Services for the Medicaid Expansion Population
Chapter VI: Access to Care
Chapter VII: Other Reproductive and Sexual Health Programs
Appendix: CMS Guidance and Additional Resources


The National Health Law Program (NHeLP) has launched a five-part webinar series entitled “Advancing Reproductive and Sexual Health in Medicaid.” Watch recordings of the webinar below.

Overview of the Medicaid Program – Watch Recording here
Medicaid Eligibility – Watch Recording here
Reproductive and Sexual Health Services Under Full-Scope Medicaid – Watch Recording here
Family Planning and Expanded RSH Medicaid Programs (March 10) – Register here
Barriers to Reproductive and Sexual Health Care (March 24) – Register here

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