Variability in Rebimbursement Charges for State-funded Abortion Providers for Medicaid Enrollees: A 2026 Replace

In 2023, medication abortion, a two-drug routine utilizing mifepristone and misoprostol that’s FDA-approved to terminate pregnancies as much as 10 weeks within the U.S., accounted for 65% of all abortions. This share has elevated for the reason that FDA eliminated the in-person allotting necessities in 2021, making treatment abortion by way of telehealth, mail, and pharmacies extra accessible. 

Remedy abortion might be billed utilizing three separate process codes, and sometimes all three codes are billed on the identical time. There are codes for 2 prescription drugs—mifepristone (HCPCS S0190) and misoprostol (HCPCS S0191)—in addition to a worldwide treatment abortion code (HCPCS S0199) that features all affiliated companies and provides (e.g., affected person counseling, workplace visits, affirmation of being pregnant by HCG, ultrasound to verify length of being pregnant, ultrasound to verify completion of abortion). 

States sometimes take two approaches to reimburse for treatment abortion companies: (1) a bundled fee utilizing the worldwide treatment abortion code plus the drugs (billed both via medical companies or pharmacy billing channels); or (2) fee for separate companies, like workplace visits and ultrasounds, plus the drugs. 

Twenty out of 21 states that use state funds to pay for abortion companies for Medicaid enrollees record reimbursement charges for a minimum of one of many three treatment abortion codes, with 16 itemizing charges for the worldwide treatment abortion code, 13 itemizing charges for mifepristone, and 12 itemizing charges for misoprostol. The one state not accounted for is New York; whereas they don’t reimburse for the worldwide treatment code, on their publicly accessible payment schedule they reimburse on the “price” of the medication to abortion suppliers for each mifepristone and misoprostol. The median Medicaid reimbursement price for the worldwide treatment abortion code is $514, starting from a low of $81 in Rhode Island to a excessive of $825 in Washington (Determine 2). The median reimbursement price for mifepristone is $81, starting from a low of $43 in Washington to a excessive of $128 in New Jersey. The median reimbursement price for misoprostol is $2, which ranges from lower than $1 in Washington to $22 in Illinois. When the median quantities for all three treatment abortion codes are summed collectively, the median reimbursement price for treatment abortion is $597. Nonetheless, the vary of summed codes throughout states is sort of giant, from $162 in Rhode Island to $869 in Washington.

For the 5 states that don’t use the bundled, world code for treatment abortion, the sum of the charges for mifepristone and misoprostol alone vary from $44 in Minnesota¹ to $131 in New Jersey. In these states, suppliers might invoice individually for ancillary companies, which may doubtlessly add further reimbursement (Desk 1).

The treatment abortion reimbursement charges reported on this transient apply to companies supplied in outpatient clinics or physicians’ places of work and don’t particularly deal with reimbursement charges for telehealth treatment abortion for both bricks-and-mortar or online-only suppliers. Telehealth has change into an more and more widespread mode of treatment abortion provision; in 2025, roughly 28% of all abortions had been treatment abortions supplied via telehealth, representing a 27% total improve from 2024. Though analysis on Medicaid reimbursement charges for telehealth treatment abortion is proscribed, a 2024 report from the Nationwide Health Legislation Program discovered that, throughout six states (Illinois, Minnesota, New Mexico, New York, Rhode Island, and Washington), there was total fee parity for synchronous video telehealth service supply below Medicaid in comparison with in-person treatment abortion service supply. Nonetheless, many of those states adopted short-term telehealth fee parity insurance policies in response to the COVID-19 public Health emergency, and a few of these insurance policies haven’t but been made everlasting, limiting the generalizability of those findings. 

Whereas most states that use their very own funds to pay for abortion companies for Medicaid enrollees record reimbursement charges for treatment abortion, solely half of the states that comply with Hyde restrictions record reimbursement charges for treatment abortion, and median reimbursement in these states is considerably decrease (see Appendix Desk 1). Past the problem of failing to publish reimbursement charges for treatment abortion, a 2025 U.S. Government Accountability Office (GAO) report discovered that 14 states taking part within the Medicaid Drug Rebate Program (MDRP) weren’t complying with federal necessities to cowl FDA-approved treatment abortion medication, even in circumstances permitted below the Hyde Modification, similar to rape, incest, or life-endangerment. The GAO reported these situations of noncompliance to the Facilities for Medicare and Medicaid Providers (CMS) in late 2025.