Objective: To compare post-abortion long-acting contraception (LARC) use, continuation, and subsequent pregnancy among women who were and were not eligible to participate in a Medicaid 1115 waiver program that provided these methods at no-cost. Methods: We conducted a prospective study of 518 abortion patients at Planned Parenthood in Austin, Texas. Low-income, uninsured, Travis County residents were eligible for the Medicaid waiver program. Waiver ineligible women were divided into two groups: low-income, uninsured, non-Travis County residents; and not low-income/insured. We compared pre-abortion preference for LARC, post-abortion LARC use and continuation, and subsequent pregnancy, over 14 months among those who were waiver eligible and ineligible. Results: Preference for post-abortion LARC was high among all three groups (68% – waiver eligible, 47% – low-income ineligible, and 60% – higher-income/insured), however, waiver eligible participants were significantly more likely to receive LARC (65% vs. 5% and 24%, respectively, p<0.05). Among eligible and insured/higher-income women who received post-abortion LARC, continuation at 14 months was greater than 85%. Uninsured, low-income, ineligible women were significantly more likely than eligible women to become pregnant by 14 months (HR 3.28, 95% CI 1.15,9.31). Conclusion: Preference for post-abortion LARC was high, however, uninsured, low-income women without access to free LARC were far more likely to use less effective or no contraception and become pregnant. Women with access to free LARC were more likely to use and continue these methods. In Texas, where abortion providers are barred from receiving state family planning funds, specialized funding programs can play an important role in immediate post-abortion contraceptive provision.