This map is a joint project of the National Health Law Program and the Reproductive Health Initiative for Telehealth Equity & Solutions (RHITES).
Methodology
We conducted an in-depth analysis of relevant state statutes, regulations, and court rulings that impact either abortion or telehealth policy in the seventeen states that use their own funding to provide abortion coverage to Medicaid enrollees. We also looked at an additional four states (CO, MI, NV, PA) that have ongoing litigation or ballot initiatives that would establish abortion coverage for Medicaid enrollees. We also examined state Medicaid agency materials, including provider manuals, fee schedules, bulletins, and other guidance issued by state agencies and professional boards. Please note that this analysis was conducted at a particular point in time, and given the rapidly changing policy landscape, some of these policies may have changed at the time of reading. NHeLP and RHITES are committed to supporting advocates to remedy any issues impacting coverage for abortion care and TMAB access in their state and we encourage you to contact Cat Duffy ([email protected]) or Natalie Birnbaum ([email protected]) to lift any discrepancies to our attention.
Map Highlights
- States that Use Their Own Funding for Abortion Coverage: 18 States (Alaska, California, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington)
- Synchronous Audio-Video TMAB Coverage: 18 states (Alaska, California Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington)
- Synchronous Audio-Only TMAB Coverage: 15 States (Alaska, California, Delaware, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, New Mexico, New York, Oregon, Rhode Island, Vermont, and Washington)
- Synchronous Audio-Only TMAB Policies are Temporary: 3 States (Illinois, Maryland, and Minnesota)
- Asynchronous Store-and-Forward TMAB Coverage: 10 States (Hawaii, Illinois, Maine, Massachusetts, Minnesota, Montana, New Jersey, Oregon, Rhode Island, and Washington)
- States with Ongoing Litigation or Ballot Initiatives That Would Establish Abortion Coverage: 4 states (Colorado, Michigan, Nevada, Pennsylvania)
- Synchronous Audio-Only Telehealth Coverage: 3 states (Colorado, Nevada, Pennsylvania)
- Asynchronous Store-and-Forward Telehealth Coverage: 2 states (Michigan, Nevada)
- States where Abortion Coverage for Medicaid Enrollees is Restricted: 32 states and the District of Columbia. (Alabama, Arizona, Arkansas, Colorado*, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan*, Mississippi, Missouri, Nebraska, Nevada*, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania*, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming)
Map Glossary
- Telehealth: Telehealth enables health care clinicians to treat patients virtually without an in-person appointment. Patients can connect directly with a healthcare clinician from any location and this can be done in a variety of modalities ways, including via live synchronous video, synchronous audio-only, and asynchronous store-and-forward modalities, such as video (“synchronous”), the phone, secured chat (“asynchronous”), and other telecommunications. This can be delivered direct-to-patient, site-to-site, or via hybrid in-person/virtual care.
- Telehealth for Medication Abortion (“TMAB”): Generally refers to a patient’s use of a phone and/or video with a provider for some or all of the interactions to prescribe and receive medication abortion. TMAB can be direct-to-patient, site-to-site, or through a hybrid in-person/virtual care experience using different modalities.
- Hybrid Telehealth Care: The provision of telehealth for medication abortion care can be provided by telehealth in part, but not in entirety, because of state-mandated policies requiring a patient to have an in-person interaction.
- Medicaid: Medicaid, a joint federal and state program, is the largest source of federally supported health care coverage. In exchange for federal funding, states must meet several requirements governing eligibility, what services must be provided, and protections for enrollees. While federal requirements establish a floor, states have flexibility in designing and administering their programs, including wide latitude over determining telehealth coverage.
- Abortion Coverage for Medicaid Enrollees: While federal funding for Medicaid abortion coverage is limited to cases of life endangerment, rape, or incest, states can use their funding to provide coverage for all abortions for Medicaid enrollees. Comprehensive insurance coverage is crucial to facilitating equitable abortion access.
- Hyde Amendment: The Hyde Amendment is an annual federal budget rider that restricts federal funding for abortion services to the narrow circumstances of rape, incest, or life endangerment.
- Telehealth Modalities: Telehealth care can occur in various forms known as “modalities.” While each state’s definition varies, the three primary forms of care are listed below:
- Asynchronous Store-and-Forward: This modality allows patients and providers to exchange information, such as pictures, dynamic intake forms, lab results, and direct messages, to receive care in non-real-time interactions. Generally, the patient sends information and care requests to a provider that are then “stored” until the provider reviews it and responds.
- Synchronous Audio-Only: This modality uses real-time audio-only interactions between a patient and provider (such as telephone calls using a secure audio conferencing platform).
- Synchronous Audio-Video Interactions: This modality uses a secure live video platform for interactions between a patient and a provider. It represents the most commonly covered modality and is often what people think of when considering telehealth service delivery.
- Brick & Mortar Facility Requirement: A state-mandated requirement that a provider or clinic must have a brick-and-mortar facility or physical presence in the state to be eligible to enroll as a Medicaid provider and/or receive coverage for services. These requirements vary widely from state to state.
Map Table
KEY
⏺ The state covers this modality
○ The state covers this modality in limited circumstances, however, TMAB does not fall within this category
◫ The state has a brick-and-mortar facility requirement
✶ Denotes the coverage policy is temporary
^ Only hybrid telehealth care is available in this state due to a mandated in-person dispensing requirement
