State Medicaid directors have protested a directive from the Clinton administration ordering them to provide abortion coverage in cases of rape or incest.
The battle offers a preview of the impending controversy over abortion coverage in the context of national healthcare reform. At a meeting with reporters last week, the director of HCFA's Medicaid Bureau, Sally Richardson, called abortion "the most value-laden decision in the healthcare arena," with the "strongest advocates on both sides."
The directive, issued by Ms. Richardson late last month, implements a change in federal law that lifted the Medicaid funding ban on abortions for pregnancies arising from rape or incest. Previously, coverage was allowed only to save the mother's life.
In a letter informing states of the new mandate, Ms. Richardson said that the relaxation on restrictions meant that abortions for those circumstances had been deemed medically necessary by Congress and had to be included in Medicaid-covered services.
But in a letter to HCFA Administrator Bruce Vladeck, one state Medicaid official argued that the change in federal law was intended to give states the option to cover such abortions, not require them to do so.
"This situation imposes another unfunded federal mandate with apparently no notice or allowed time for comment," said Ray Hanley, chairman of the State Medicaid Directors' Association and head of the Arkansas Medicaid program. Mr. Hanley said HCFA lacked the legal authority to implement the mandate and said at least 10 states would have to change state law to comply.
"HCFA's directive clearly doesn't allow time for such action and boldly threatens loss of all federal funds unless state plans are filed within 90 days removing all barriers to the expanded abortion coverage."
There was no estimate of the cost of complying with the new order.
Mr. Hanley said he was writing on behalf of all Medicaid directors. At least two state directors, from Louisiana and South Dakota, wrote letters of support for Mr. Hanley's position.-Lynn Wagner