Why the South Matters in Health Care and Reproductive Freedom Advocacy (And What We Are Doing About it)

Why the South Matters in Health Care and Reproductive Freedom Advocacy (And What We Are Doing About it)


It is no secret that the U.S.South – home to a significant portion of Black, Indigenous, and other people of color – has been shouldering the brunt of legislative restrictions in health care and reproductive freedoms. The repeal of Roe v. Wade in June 2022 has effectively led to complete abortion bans in 15 states, 11 of which are in the South. The repercussions of eliminating the constitutional right to abortion are becoming increasingly apparent, as exemplified by a recent Supreme Court decision in Alabama.

However, while much attention is rightly given to abortion access, it is important to recognize that abortion is just one piece of a larger crisis in the South: the systemic lack of access to sexual and reproductive health services. This critical health care is limited because many Southern states have refused to expand Medicaid and to re-enroll Medicaid beneficiaries who lost benefits at the end of the COVID-19 public health emergency. Many Southern states are also failing to provide proper, informative notices to individuals who have lost full Medicaid coverage but may still qualify for family planning Medicaid programs

Medicaid-related Disparities in the South 

States that have not expanded Medicaid have left 1.9 million people in the “Medicaid coverage gap” without access to health care, 1.4 million of whom are located in Texas, Florida, and Georgia alone. The Medicaid coverage gap encompasses people whose incomes are too high to be eligible for Medicaid, but too low to access the Affordable Care Act’s marketplace. Out of the 10 states that have not expanded Medicaid, 8 are in the South. Medicaid expansion has significant implications for the health and well-being of beneficiaries. It is also a matter of racial equity – expanding Medicaid in states has led to a reduction in racial and ethnic disparities in health coverage. 

After the COVID-19 public health emergency, Medicaid programs were required to maintain enrollment for individuals. Now, with the “end” of the public health emergency, millions of people across the nation are losing coverage, with 1.4 million in Texas and nearly 1 million in Florida alone. This is called “unwinding,” and communities of color are disproportionately impacted as they make up more than half of Medicaid enrollees. According to the Southern Poverty Law Center, states that have not expanded Medicaid (i.e. the Deep South) are especially impacted as more people will fall into the coverage gap. 

Additionally, while many Southern states have special family planning Medicaid programs in the form of an § 1115 waiver or State Plan Amendment, we have heard through our partners that many people are unaware that they have or can be enrolled into those programs. This often happens to those who previously had Medicaid when they were pregnant and were removed from the program once the pregnancy ends. These states are not meeting federal requirements by providing appropriate notices to Medicaid beneficiaries or those eligible for the program. 

Sexual and Reproductive Health Advocacy in the South 

The South is home to more than half of the U.S. Black population and the largest population of LGBTQ-identifying individuals in the entire country. Ignoring the South means writing off one of the most diverse communities in the country. It is also a mistake to believe the South can be reduced to a monolith of anti-progress and conservatism. The issues discussed above are just a few examples of the many tough barriers to health care that many Southern advocates are battling against. However, these issues should not be the reason people dismiss the South, but rather, be inspired by it.

The Southern Sexual and Reproductive Health, Rights, and Justice & Medicaid Advocates – Southern Advocates Network for short – was established to provide a space specifically for the work intersecting reproductive justice and Medicaid. The organizations in this network are doing tremendous work: providing legal representation, offering health care services, and conducting policy advocacy on behalf of the most vulnerable communities in the South and across the entire country. 

For example, a group of three organizations – Birth in Color RVA, Charlotte Center for Legal Advocacy, and Yellowhammer Fund – will team together to write a model notice so that enrollees who are moved from full-scope coverage to Medicaid Family Planning Expansion coverage after a redetermination are aware of and understand their new coverage. We hope that many Southerners get to keep at least some coverage, and in particular access to reproductive health services. 

It is a mistake to think the South cannot progress. The Southern Advocates Network members exemplify the immense resiliency and power that exists there. If you are interested in learning more about the Southern Advocates Network, or have any questions, please contact [email protected].

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