Expanded Idaho program, sold as being pro-life, funds post-abortion care

Intentions meet reality in the state's medical welfare program

An expansion of Idaho’s medical welfare system in 2024 was sold as being pro-life: if Idaho were to expand Medicaid to cover women during their pregnancies and up to twelve months after the baby’s delivery, that would encourage more women to carry their babies to term, advocates for the policy said. They said the policy was a mother-friendly necessity because of the state’s near-total ban on abortion.

As it turns out, the federal government is requiring postpartum Medicaid coverage in support of Idaho women who have traveled to other states for abortions. The federal Centers for Medicare and Medicaid Services (CMS) told Idaho late last year that women who do not carry their babies to term, having had an abortion in another state, also must receive full coverage under the federal-state medical welfare program that lawmakers agreed to expand.

Idaho is appealing the federal government’s decision. In a letter to CMS, state Department of Health and Welfare Director Alex Adams said:

Medicaid is a system built on the principles of federalism through which states must have autonomy to administer the program, including coverage options, within the context of state law. Disregarding state policy regarding entitlement program coverage is a blatant violation of these principles; this disregard significantly hampers the ability for states to respond to new coverage opportunities established by elected state policymakers.

Idaho’s No Public Funds for Abortion Act says:

No public funds made available by the state, a county, a city, a public health district, a public school district, or any local political subdivision or agency thereof and distributed by any institution, board, commission, department, agency, official, or employee of the state, a county, a city, a public health district, a public school district, or any local political subdivision or agency thereof shall be used in any way to provide, perform, or induce an abortion; assist in the provision or performance of an abortion; promote abortion; counsel in favor of abortion; refer for abortion; or provide facilities for an abortion or for training to provide or perform an abortion.

(2) No person, agency, organization, or any other party that receives funds authorized by the state, a county, a city, a public health district, a public school district, or any local political subdivision or agency thereof may use those funds to perform or promote abortion, provide counseling in favor of abortion, make referral for abortion, or provide facilities for abortion or for training to provide or perform abortion.

(3) No fund or committee authorized by Idaho Code for the special protection of women or children shall be authorized to use or distribute public funds for payment for abortion, abortion referrals, abortion counseling, or abortion-related medical or social services.

The law doesn’t mention postpartum care so, theoretically, the preceding law doesn’t prohibit the use of public funds to cover abortion-aftercare. And Medicaid’s postpartum coverage starts when a pregnancy has ended, whether that pregnancy ends with a birth or with an abortion.

So apparently now, Idaho women are traveling to other states for abortions and then returning to Idaho, where the state, under the present arrangement with the federal government under the expanded Medicaid law from 2024 insists that the medical welfare program provide post-abortion health coverage.

Welcome to government, where state and federal laws and regulations meet the in the Land of Unintended Consequences. Pro-life legislators and groups like Idaho Chooses Life said that Medicaid expansion for postpartum women would help women bring their babies to term. As it turns out, it also helps support women who have chosen to end their pregnancies, too.

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For years, people have asked my opinion on the question of abortion. It’s an issue that, apart from the funding issue, the Idaho Freedom Foundation didn’t weigh in. For paid subscribers, I provide my personal thoughts on this issue below: