Impact of innovative health care policies on abortion access for Oregon women enrolled in Medicaid
Awarded 2017
Large Research Grants
S. Marie Harvey, DrPH, MPH
Oregon State University

Women of reproductive age with incomes below the federal poverty level (FPL) were five times more likely to report an unintended pregnancy than women living at or above 200% of the FPL. Not surprisingly, abortion patients in the US are disproportionately poor and low income. Laws such as the Hyde Amendment make it difficult for the poor to access abortion services. Although 32 state Medicaid programs adhere to the strict guidelines of the Hyde Amendment, Oregon provides abortion coverage for women on Medicaid in most cases. Moreover, Oregon has been leading national efforts to transform Medicaid programs with innovative health care policies that could impact both the need for and access to abortion services for women enrolled in Medicaid. Specifically, Coordinated Care Organizations (CCOs), which began operation in 2012 and 2013, provide integrated physical, behavioral, and oral health care to Medicaid beneficiaries to improve access and quality of care. Additionally, under the Affordable Care Act (ACA) Oregon expanded Medicaid eligibility to individuals with incomes up to 138% FPL significantly reducing the number of uninsured women of reproductive age in Oregon. We propose to investigate the impact of Oregon’s Medicaid reforms on abortion access and utilization. Specifically, utilizing Oregon Medicaid claims and eligibility data from 2008-2016, this study will: 1) describe Oregon abortion rates among women of reproductive age enrolled in Medicaid; 2) compare abortion rates in Oregon before and after the implementation of CCOs; and 3) investigate how abortion rates in Oregon were affected by Medicaid expansion under the ACA.