An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (with 2023 Supplement)

Executive Summary

In 2019, NHeLP published the 2nd Edition of An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (“Guide”). The Guide is designed to 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 (U.S.) 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.

In the years since we published the 2nd edition, the legal and policy landscape for sexual and reproductive health, rights, and justice in the U.S. has altered considerably. In 2020, the COVID-19 pandemic upended access to care while also paving the way for policymakers to test new flexibilities, such as telehealth policies that helped address long-standing barriers to health access. Various COVID-era federal legislative packages expanded Medicaid eligibility to underserved populations. After President Biden took office in January 2021, his administration swiftly began the work of undoing the Trump administration’s far-reaching actions to gut implementation of federal health care and civil rights laws. The Biden administration also prioritized countering the maternal mortality epidemic, with particular attention to expanding health insurance eligibility and quality improvement. 

Anti-abortion politicians’ long-standing efforts to pack the courts resulted in an array of harmful rulings on matters of reproductive and sexual health and justice. Most notably, in June 2022, the U.S. Supreme Court overturned the constitutional right to abortion in Dobbs v. Women’s Health Organization. This ruling not only harmed access to abortions, but pregnancy services, contraception, gender-affirming care, and related care for people with chronic conditions as well.

The 2023 Supplement (“Supplement”) provides brief overviews of these and other developments. Advocates should reference the Guide alongside this Supplement to ensure that they access both key background information and the most current legal and policy analysis on issues of interest. In this Supplement, we offer new developments related to current sections of the Guide as well as additional sections on new issues. Updates to existing sections have the same section numbers as the corresponding sections in the Guide. If there are no updates, we skip over that section number and indicate that there were no updates with an ellipsis (. . .). We enumerate new sections as if we inserted them at the end of existing sections in the Guide. The Supplement includes what we believe to be the most relevant updates from when we published the second edition of the Guide in 2019.

An Advocate’s Guide to Reproductive and Sexual Health in the Medicaid Program (2nd Ed.)

The complete Guide can be downloaded (without the 2023 Supplement) below.

Individual chapters can be accessed below.

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 2023 Supplement can be downloaded below.

2023 Supplement

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.

Note: These webinars were presented in 2020. While some of the specifics have changed, they provide a solid background understanding of Medicaid’s role in providing access to reproductive and sexual health care.

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 – Watch recording here
Barriers to Reproductive and Sexual Health Care – Watch recording here

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