The effect of Illinois Medicaid coverage of induced abortion on patient access at the University of Illinois in Chicago.

OBJECTIVES

Beginning January 1, 2018, Illinois House Bill 40 (HB40) requires Medicaid coverage of induced abortion. The objective of this study was to describe the impact of HB40 on gestational age at time of induced abortion at a single academic medical center in Chicago, IL.

STUDY

DESIGN

We used Current Procedural Terminology (CPT) codes to identify patients who induced abortion one year before (2016) and one year immediately after (2018) HB40 implementation. We collected demographic and clinical information from the electronic medical record. We used ANOVA and Chi-square tests to evaluate differences in gestational age and patient characteristics before and after the policy change.

RESULTS

Patient characteristics and indication for induced abortion before (N = 274) and after (N= 249) HB40 were similar. The mean gestational age of induced abortion was higher after HB40 (83.3 days ± 38.9 days vs 91.6 days ± 38.0 days, p = 0.01). While not statistically significant, the proportion of second trimester (>14 weeks) induced abortions increased (32.8% vs 40.6%, p = 0.07). After HB40, a smaller proportion of patients paid out-of-pocket for abortion care (2.4% vs 40.5%, p < 0.001) and more patients had an abortion with sedation (37.3% vs 49.8%, p = 0.007).

CONCLUSIONS

After passage of HB40, the gestational age at time of induced abortion increased by a median of eight days, access to abortion care was less costly to patients and more procedures were completed with sedation. To further the impact of HB40, increased awareness of expanded coverage continues to be essential.

IMPLICATIONS: With Medicaid coverage of induced abortion in Illinois, out-of-pocket cost decreased and sedation use increased in our academic medical center. To further the impact of HB40, increased awareness of expanded coverage continues to be essential.