State Medicaid insurance barriers to vasectomy coverage are associated with restrictive abortion laws.

Abstract

Objective: To determine if state populations have equitable access to vasectomy under Medicaid and evaluate the relationship between accessibility of Medicaid-covered vasectomy and state abortion restrictions.

Methods: Individual state-based Medicaid rules were assessed by publicly available data for all 50 states and Washington D.C. A novel scoring system quantifying restrictions to Medicaid coverage for vasectomy was developed utilizing state-specific Medicaid income eligibility criteria, presence or absence of extended family planning benefits, and any additional prohibitive vasectomy coverage policies (0-4 points; 0 no restrictions - 4 most restrictions).  Abortion access was quantified using the Guttmacher Institute's ranking of state abortion policy restrictions (1 most protective, 7 most restrictive). Fisher's exact test (α < 0.05) was used to evaluate the relationship between vasectomy access score and abortion access.

Results: Fifty-one Medicaid regions (50 states and Washington DC) were analyzed. For vasectomy access, each had a point assigned for a mandatory 30-day waiting period. Eighteen states (35%) had only 1 point assigned, 25 (49%) had 2, and 7 (14%) had 3 points. Texas was the only state to receive 4 points, correlating with the greatest number of barriers to vasectomy, due an additional consent form beyond the conventional paperwork. There was a statistically significant relationship between state Medicaid vasectomy coverage and restrictions on abortion access (p=0.01). States with more barriers to Medicaid vasectomy coverage were more likely to have laws restricting abortion.

Conclusions: Access to vasectomy under Medicaid varies greatly by state. States with the most limited access to coverage also had the most restrictive abortion laws.