TELEHEALTH EQUITY AMONG PATIENTS WITH MEDICAID

Objectives

Telehealth, which now comprises 20% of all abortion care, has been celebrated as a mechanism to improve health equity by making abortion care more convenient and affordable. However, many patients with Medicaid are not able to use their insurance to pay for their telehealth abortion. We sought to document and compare patient experiences between those who could and could not use their Medicaid insurance to pay for their abortion.

Methods

Working with six telehealth clinics serving patients across the US, we recruited telehealth abortion patients who indicated they had Medicaid insurance, regardless of whether they were able to use their insurance, to participate in an online survey. Patients were eligible if they were enrolled in Medicaid, were at least 14 years old, had had a medication abortion within the last 1-6 weeks, and were fluent in English or Spanish. The survey was available in English and Spanish and contained questions about participant demographics, pregnancy history, and their recent telehealth abortion experience.

Results

Among 359 enrolled participants, about half (n=159) could not use their Medicaid insurance to cover their abortion. Those in this group spent an average of $261 for their abortion care (range: $0-$970). Those with no Medicaid coverage were significantly more likely to report that their financial stress was worse than before the abortion (35% vs. 4%, p<0.001).

Conclusions

Medicaid coverage makes a difference even for telehealth abortion, which is a less costly abortion option. These findings support efforts to overturn telehealth and Medicaid coverage restrictions, and establish coverage and payment parity for telehealth services.