Iowa governor opposes abortion and gives final say on whether Medicaid pays for it – KFF Health News

DES MOINES, Iowa Any hospital or clinic in Iowa seeking Medicaid payment to provide abortions will need approval from the state’s most prominent opponent of abortion: Gov. Kim Reynolds.

No one bothers to try.

Iowa’s Medicaid regulations include an unusual policy that requires sign-off from the governor’s office before the public health insurance program can pay for any abortion services, even if they meet the state’s strict criteria.

Reynolds is a Republican and a staunch opponent of abortion. In more than six years as governor, she has never been asked to approve Medicaid payment for an abortion, said her spokesman, Colin Crompton.

The new policy, enacted a decade ago by lawmakers, leaves abortion providers with a choice: absorb the cost of the procedure or risk a showdown with the governor.

The state Medicaid program spends about $8 billion a year to cover about 800,000 Iowans with low incomes or disabilities. It allows payment for abortions if the pregnancy threatens the woman’s life, is the result of rape or incest, or involves a deformity of the fetus. The Iowa Department of Health and Human Services publishes a form for abortion providers to fill out for Medicaid reimbursement, but the program has not paid for abortions in several years, spokesman Alex Carfrae said.

The federal government, which funds more than half of Medicaid costs, helps pay for abortions only in cases of rape or incest or when the pregnancy threatens the woman’s life. But it requires state Medicaid programs to cover such cases.

Most state Medicaid programs pay for at least some abortions, according to a 2019 report from the federal Government Accountability Office. The report found that in fiscal years 2013 through 2017, only Iowa, South Dakota and Wyoming reported not covering abortions that met federal criteria.

Abortion remains legal during the first 20 weeks of pregnancy in Iowa, where 4,062 abortions were reported in 2022. Reynolds signed a law in July that would ban most abortions after six weeks, and she is fighting in court to enforce the law. However, the abortion ban would allow exceptions for cases of rape, incest, fatal fetal abnormalities and medical emergencies.

Iowa’s Medicaid program paid for 22 abortions in the fiscal year before lawmakers passed the governor’s oversight rule in 2013. Most were performed at the University of Iowa Hospitals and Clinics in Iowa City, a state institution that handles many of Iowa’s most complicated pregnancies. After the rule went into effect, hospital leaders decided to pay for such abortions out of facility revenue instead of trying to bill Medicaid.

Jean Robillard, then a vice president at the University of Iowa, declined to explain how the state rule affected the decision to stop Medicaid billing for abortions. “I don’t want to get involved in the politics of this,” he told the Des Moines Register.

University of Iowa spokeswoman Laura Shoemaker said this fall that the hospital has not billed Medicaid for abortions in recent years. She declined further comment.

UnityPoint Health, a large nonprofit hospital system based in West Des Moines, also occasionally billed Iowa Medicaid for qualified abortions before the governor’s approval rule took effect. UnityPoint declined to comment on its current practice.

When the rule was implemented, it was singled out by the Guttmacher Institute, a national nonprofit that supports abortion rights. The group still cites Iowa as the only state that requires the governor’s permission for Medicaid payments for abortion. But the spokesman said the institute could not say with certainty that no other state had implemented such a rule.

The policy took effect while Reynolds’ predecessor, Republican Terry Branstad, was in office. Branstad also opposed abortion but proposed that the rule be repealed. A spokesman for Reynolds declined to say whether the current governor approves the rule.

Maggie DeWitt, executive director of Pulse Life Advocates, an Iowa-based group that opposes abortion, said she supports the policy as a way to limit the use of taxpayer dollars for the procedure.

“I don’t think it’s something the government should pay for.” It is the taking of an innocent life,” she said. “We need to have as many stops along the way as possible.”

Sally Frank, a law professor at Drake University in Des Moines who studies women’s rights issues, said the rule appears to be intended to prevent claims for Medicaid payments. “It’s kind of set up to fail,” she said.

Frank, who supports abortion rights, said a hospital or clinic would have strong legal grounds to challenge any denial by the governor of Medicaid payment for an abortion that meets Iowa’s criteria. She noted that states are required to cover Medicaid services listed under federal law. She added that if the governor blocks payment without giving a valid reason, the provider could argue in court that they were denied due process. “It shouldn’t be up to the governor’s discretion.”

But she wasn’t surprised to hear that no hospitals or clinics were challenging the policy, given the state’s increasingly conservative politics.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFFan’s independent source for health policy research, polling and journalism. Learn more about KFF.


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