New research led by UW Collaborative for Reproductive Equity postdoctoral scholar Taehyun Kim shows that after Illinois introduced Medicaid coverage for abortion care, more Illinois residents were able to access abortion services.
The Hyde Amendment, passed in 1976, bans federal Medicaid spending on abortion, even though Medicaid covers prenatal and birthing care costs. Some U.S. states arrange for state Medicaid funds to cover abortion services. Illinois recently became one of those states, and researchers wanted to find out what happened to people’s use of abortion services as a result.
The study highlights the role Medicaid can play in improving access to abortion care and reducing financial barriers.
Illinois began covering abortion under Medicaid in January 2018. Kim and colleagues assessed the policy’s impact on abortion and birth rates of state residents by reviewing CDC data from four years before (2014-17) and four years after (2018-21) the change.
The study, published in Health Affairs, highlights the crucial role Medicaid can play in improving access to abortion care and reducing financial barriers. Key findings include:
- More than 6,100 additional abortions took place over four years for Illinois residents — an increase of 18%.
- The impact of Medicaid coverage on abortion access in Illinois happened immediately and grew over time.
- Since Black and Hispanic individuals are more likely to be Medicaid enrollees than white individuals, Medicaid abortion coverage is critical to advancing reproductive equity.
The study also found that Medicaid coverage for abortion led to a 3% decrease in birth rates among Illinois residents, equivalent to about 4,200 fewer births per year. The decline in birth rates was more pronounced among Black and Hispanic patients, residents in high-poverty counties, and those living closer to an abortion facility.
As of February 2025, 19 states use state funds to cover abortion care in their Medicaid programs. In contrast, nearly 9 million people — more than half of reproductive-aged females with Medicaid — live in states that do not cover abortion in Medicaid.
Wisconsin is one of those states. State law prohibits Medicaid or state employee insurance coverage for abortion in the Badger state.
More than half of reproductive-aged females with Medicaid live in states that do not cover abortion in Medicaid.
The authors note:
- Insurance coverage prohibitions can be a huge financial barrier to abortion care. Paying for abortion out-of-pocket can be prohibitively expensive.
- The Hyde Amendment places unequal burdens on those living on low incomes and Black and Hispanic people, who are disproportionately served by Medicaid.
As state abortion policies evolve following the U.S. Supreme Court’s 2022 Dobbs decision, Medicaid abortion coverage will remain a vital factor in reproductive access, the authors conclude.