Adult women of reproductive age (19 to 49) comprise a quarter (24%) of the Medicaid population (Figure 1). Medicaid covers a wide range of reproductive health care services, including family planning, and pregnancy-related care including prenatal services, childbirth, and postpartum care—all without cost-sharing. Medicaid coverage of abortion services, however, is very limited under federal law and in most states.
Family planning
Federal law requires state Medicaid programs to offer family planning benefits, but states determine the specific services and supplies for those who qualify through pre-ACA pathways. For the ACA expansion populations, the ACA requires states to cover all FDA approved, granted, and cleared contraceptive methods, counseling on STIs and HIV, and screening for breast and cervical cancers. Research has found that most states have aligned their benefits and cover these services across all eligibility groups.
- The federal government pays 90% of costs for family planning services, a higher federal matching rate than for other services (typically between 50% and 78%). Women covered by Medicaid cannot be charged any out-of-pocket costs for family planning services.
- Federal law states that Medicaid beneficiaries have “free choice of provider,” which allows them to seek care from any qualified participating provider that offers the services. However, contrary to longstanding interpretation of the free choice of provider clause, a 2025 Supreme Court ruling, Medina v. Planned Parenthood South Atlantic, allows state Medicaid programs to disqualify clinics from participating in their networks if they offer abortion care in addition to other medical services. As of June 2026, at least seven states (AR, MO, MS, NE, OK, SC, and TX) have bans on Planned Parenthood’s participation in Medicaid, and several other states have proposed similar policies. Nationally, one in ten (10%) reproductive age women covered by Medicaid who received family planning services got their care at a Planned Parenthood clinic in 2023.
- In addition to the Medina ruling, H.R.1 established a one-year ban on federal Medicaid reimbursements to Planned Parenthood in all states and some other reproductive health providers that provide abortion services. The policy was in effect from July 2025 to July 2026. While this rule expired, future legislation could be enacted by Congress to reinstate this funding ban.
- Over half of states currently operate limited scope Medicaid family planning programs, which extend access to family planning services to uninsured women who do not qualify for full Medicaid coverage (often because their incomes exceed the Medicaid income thresholds).
Maternity Care
Medicaid is the largest single payer of pregnancy-related services, financing 40% of all U.S. births in 2024. In three states Medicaid covers more than 50% of all births. By federal law, all states provide Medicaid coverage without cost sharing for pregnancy-related services to pregnant people with incomes up to 138% of the federal poverty level (FPL), but many states extend eligibility to those at higher income levels.
- Similar to family planning, there is no federal definition of what services states must cover under their traditional Medicaid programs for pregnant women beyond inpatient and outpatient hospital care, but states that have expanded Medicaid eligibility must cover all preventive services recommended by the United States Preventive Services Task Force (USPSTF) to individuals who qualify through this pathway, which includes a broad range of pregnancy-related preventive services. Overall, most states cover a broad range of maternity care services, including prenatal screenings, folic acid supplements, and breastfeeding supports. States may not charge cost-sharing for any pregnancy-related services.
- Historically, Medicaid coverage for pregnant people ended after 60 days. Due in part to the high rates of maternal mortality and morbidity in the United States and the disproportionately high rates of poor maternal outcomes experienced by Black and Native American pregnant people, there was a growing interest in expanding postpartum coverage beyond the 60 days. The federal American Rescue Act of 2021 gave states the option to extend postpartum coverage to pregnant people to a full year. To date, all states, with the exception of Arkansas, have extended postpartum coverage to 12 months.
- In the 10 states that have not expanded Medicaid coverage under the ACA, many women lose Medicaid eligibly after the postpartum period. This is because the income eligibility for pregnancy-related care is typically considerably higher than that offered to parents of dependent children. Eligibility levels for parents in the states that have not expanded Medicaid range from 15% FPL in Texas to 105% FPL in Tennessee (Figure 4). In the states that have expanded Medicaid eligibility, most women with Medicaid financed births are able to remain enrolled in the program and have continuous coverage beyond the postpartum period.
Abortion
While the 2022 Dobbs decision overturning Roe v. Wade eliminated federal protections and allowed states to ban or severely restrict the provision of abortion, abortion remains legal and available in many states. However, the federal Hyde Amendment prohibits federal spending on abortions in all states, except when the pregnancy is a result of rape or incest, or when it jeopardizes the life of the pregnant person (Figure 5). States may use their own unmatched funds to cover abortions in other circumstances. As of July 2026, 29 states (including the 13 states where abortion provision is currently banned) and DC follow Hyde restrictions and 21 states cover abortions for Medicaid beneficiaries that are considered to be “medically necessary” and pay for these using only state funds. Nearly half of women of reproductive age with Medicaid coverage live in a state that follows Hyde amendment standards or currently bans the provision of abortion. In cases when Medicaid finances abortions for Medicaid enrollees, reimbursement rates tend to be low and often do not cover the full cost of the procedure.
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