Jumping Through Medicaid Hoops

Recorded:
Sep 2024
Speaker
Dr. Nisha Verma
Duration
3:04
AUDIO CLIP
TRANSCRIPT

Dr. Nisha Verma: I came back to fellowship in Georgia in 2019. So my fellowship was 2019-2021. I did fellowship before our six-week ban went into effect. But we still had multiple restrictions. There’s the 24 hour waiting period, we had insurance coverage issues, mandatory [legislative] counseling. So there was all of parental notification laws. There were multiple restrictions in place that I didn’t deal with in Massachusetts that then really affected care. So for example, with the insurance coverage limitations, in Georgia a lot of private insurances don’t cover abortion care and then a lot of our patients have Medicaid. With the Hyde amendment, Medicaid only covers abortion in the situation of life endangerment or rape and incest. Pretty regularly we see patients who are sick: they have high blood pressure, or diabetes, or conditions that are going to get worse in pregnancy but they don’t meet this super strict criteria for medical emergency, so they get denied by Medicaid. Also just the logistical burden. Instead of just being able to provide the care, I was having to do peer-to-peers with Medicaid where you essentially have to get on the phone with an internal medicine doctor or urologist who has no experience with abortion care trying to defend why this patient should get their abortion. Fetal anomalies are completely excluded from the Hyde Amendment, even a lethal fetal anomaly. So I still remember the first time I had a patient, he was active duty in the army. His wife was pregnant. It was a planned pregnancy. They were diagnosed with a lethal fetal anomaly, and they didn’t realize their army health insurance doesn’t cover abortion. They came in to see me and then realized. They had this huge sense of betrayal that they’re actively serving the country and the health insurance they are getting from the federal government doesn’t cover abortion care even in this setting. We saw that insurance coverage has been a huge issue in terms of access to care. The 24 hour consent period creates huge issues. I had multiple patients who traveled. Now and before our six week ban, we see patients traveling from long distances. Like before our six week ban, we were able to provide a lot of the abortions for much of the Southeast. So we were seeing patients traveling significant distances. We would have patients come in from hours away for their abortion who didn’t realize there was a 24 hour consent law. And then we’d have to tell them: “Unfortunately we can’t do this today.” We have to wait 24 hours for really no reason except for the law, which is tough.

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