Changes in early abortion access among out-of-state abortion patients in Illinois, following public insurance coverage through state Medicaid: A brief research report

In 2018, Illinois implemented House Bill 40 (HB40) which required Medicaid (means-tested public insurance) coverage of abortion care for Illinois residents. Medicaid coverage of abortion increases financial accessibility, which oftentimes leads to earlier access to care for covered patients. The ability of residents to use Medicaid may have increased the availability of financial assistance for non-residents. However, whether Medicaid coverage is associated with any changes in abortion access among out-of-state patients - who cannot use Medicaid for abortion coverage - is unknown. To explore if Medicaid coverage of abortion is associated with changes in abortion access for out-of-state patients, we analyzed de-identified records of abortion visits among non-Illinois residents presenting for abortion care across 12 Illinois health centers. We used logistic regression to assess if presenting early for an abortion (≤11 weeks gestation) was associated with implementation of HB40 (2017 vs 2018-2019). Although out-of-state residents were more likely to present early if they received abortion care in the post-HB40 period than pre-HB40 (81% at ≤11 weeks in 2018-2019 vs 78% in 2017), multivariable regression shows that HB40 was not associated with early abortion access when controlling for other patient characteristics. Out-of-state patients had higher odds of presenting ≤11 weeks of gestation during the study period if they were a resident of a state bordering Illinois (OR 1.89, 95% CI 1.55-2.30, p < 0.001) or were over the age of 24 (OR 1.50, 95% CI 1.35-1.66; p < 0.001). Given the significant rise in out-of-state patients after the Dobbs decision, future research should explore how large increases in patient volume over time have impacted abortion care in Illinois and other states, and assess how federal and state-level legal or policy changes influence abortion access for out-of-state patients.