Changes to Iowa Medicaid abortion rules untested

DES MOINES, Iowa (AP) — Iowa’s new policy that the governor must sign off on reimbursement approval for Medicaid-funded abortions remains untested one month in.

Tim Albrecht, a spokesman for Gov. Terry Branstad, said no reimbursement claims for abortions have been submitted since the rule took effect July 1. Branstad signed the legislation — thought to be unique to Iowa — in June.

Iowa’s Medicaid program covers a small number of abortions each year due to rape, incest, fetal deformity or to protect a mother’s life. Under the new policy, the anti-abortion rights Branstad will have to approve those payments.

Without a test case, it’s still hard to know exactly how this new process will work. Albrecht declined to answer questions about the criteria Branstad will use to review the funding requests or if he will take advice from the Department of Human Services, only saying that Branstad will deal with the claims on a “case by case basis.”

“We do not engage in hypotheticals and will need to examine each claim for taxpayer-funded reimbursement on its own merits,” Albrecht said in an email.

Jill June, president of Planned Parenthood of the Heartland, said she thought there should be more clarity on how the new process will work.

“I think the public deserves nothing less than that,” June said. “Otherwise the public is left to wonder if the governor is in a good mood or not.”

Iowa Medicaid Enterprise Director Jennifer Vermeer said the claim process has not changed for medical providers, who will still need to submit paperwork verifying the abortion, along with other medical records to the Department of Human Services.

The change in reimbursement for abortions was negotiated this spring in the politically divided Legislature, where Republicans control the House and Democrats the Senate. The abortion rule is part of a complex health care bill that included accepting additional federal dollars to expand low-income health care in the state — a key priority for Democrats.

Republicans hope by putting the decision into the hands of an anti-abortion governor, fewer public dollars will be spent on abortions. Democrats said they expect no changes, but abortion rights advocates fear it could restrict access to abortions for poor women.

“Your provider isn’t going to know whether the government is going to pay that bill or not,” June said. “That will be a concern.”

If Branstad were to stop authorizing Medicaid funding for all abortions, that could put the state in violation of Medicaid rules and risk losing other federal funding. Branstad has said he wants to stay in compliance with federal guidelines, which require the state to pay for abortions involving Medicaid recipients in cases of rape, incest and to save the mother’s life.

Iowa also offers state funding in cases of severe fetal deformities. Albrecht did not respond to questions about if Branstad would apply a different standard to those requests than has been used in the past. DHS has approved funding in severe cases, like when the fetus has no brain stem or cranium.

The Iowa Department of Human Services reported 12 abortions paid for by state and federal Medicaid dollars during the last fiscal year, which ended June 30, costing$16,132.

Under the current system, Medicaid reimburses medical providers for abortions after an extensive review that includes checking doctors’ reports and ultrasound results.

Republican Rep. Matt Windschitl, who came up with the idea for changing the system during budget negotiations, said he had told the governor’s office that he hoped the change would reduce the amount of taxpayer money going to abortions. He said the governor’s office had told him they would review the cases with due diligence.

Windschitl said that given the divided Legislature, anti-abortion advocates had no other options.

“This was the only route we could go down,” he said.

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