Medicaid Coverage for Women

Medicaid Coverage for Women Introduction Medicaid, the nation’s health coverage program for people with low incomes, provides more than 39 million women across the nation with health and long-term care coverage. Women comprise the majority of the adult Medicaid population and the program offers coverage of a wide range of primary, preventive, specialty, and long-term care services that are important to women across their lifespans. Given the importance of the program for women and their families, changes to the program, such as the 2025 federal policy changes to Medicaid and the enactment of new work requirements for the Medicaid expansion population, will have significant implications for low-income women’s access to coverage and care. This data note presents key data points describing the current state of the Medicaid program as it affects women. Who is Eligible for Coverage? In 2023 adult women comprised 37% of the overall Medicaid population and the majority of adults on the program (Figure 1).1 Prior to the 2010 Affordable Care Act (ACA), women were more likely to qualify for Medicaid than men because of their lower incomes and because they were more likely to belong to one of Medicaid’s categories of eligibility for adults: pregnant, parent of a dependent child, senior, or person with a disability. The ACA added a new Medicaid eligibility category by extending Medicaid eligibility to nearly all adults under age 65 with incomes up to 138% of the federal poverty level (FPL), though women are still more likely than men to be covered by Medicaid. - As of May 2026, 40 states and DC have opted to expand eligibility for Medicaid under the ACA, which allows women and men with low incomes below 138% FPL to qualify regardless of their pregnancy, parenting or disability status. - In the 10 states that have not expanded Medicaid under the ACA, adults only qualify if they meet income criteria AND belong to one of the previously mentioned categorical eligibility groups. While there are federal eligibility minimums, states have the option to expand eligibility levels for each group up to certain limits. As a result, income eligibility criteria vary for different groups of beneficiaries within as well as between states. - In the states that have not adopted the ACA Medicaid expansion, approximately 576,000 women ages 19 to 64 with incomes below the federal poverty level and who are uninsured fall into a “coverage gap.” This is because they earn too much money to qualify for Medicaid in their state but not enough to qualify for assistance purchasing a private policy through their state’s ACA Marketplace, which is available for individuals with incomes between 100% FPL and 400% FPL. - H.R. 1, the 2025 budget reconciliation law, has made significant changes to the Medicaid program. For the first time, eligibility for adults in the ACA Medicaid Expansion group will be conditioned on meeting work requirements, starting January 1, 2027. Prior KFF research has shown that most adult women covered by Medicaid meet work requirements or could qualify for one of the law’s exemptions (including being a parent of a child under age 14), but they are at risk of losing coverage because of the administrative burdens related to reporting requirements. In 2023, approximately 40% of adult women enrolled in Medicaid were enrolled via the ACA expansion pathway.2 The Congressional Budget Office (CBO) estimates that these requirements will reduce federal Medicaid spending by $326 billion over the next 10 years but will also increase the number of uninsured by 5.3 million in 2034. Profile of Women Under 65 Covered by Medicaid Medicaid covers a diverse population of women who face many social, economic, and health challenges that affect their ability to receive timely and high-quality health care. - In 2024, Medicaid covered 18% of adult women ages 19 to 64 in the United States, but coverage rates were higher among certain groups, such as women of color, single mothers, low-income women, and women who have not completed a high school education (Figure 2). - Differences in Medicaid eligibility levels and poverty rates across the states translate into vastly different Medicaid coverage rates for women across states, from a low of 9% in Utah and Texas to 32% in New Mexico (Figure 3). Reproductive Health Adult women of reproductive age (19 to 49) comprise a quarter (24%) of the Medicaid population (Figure 1). Medicaid covers a wide range of reproductive health care services, including family planning, and pregnancy-related care including prenatal services, childbirth, and postpartum care—all without cost-sharing. Medicaid coverage of abortion services, however, is very limited under federal law and in most states. Family planning Federal law requires state Medicaid programs to offer family planning benefits, but states determine the specific services and supplies for those who qualify through pre-ACA pathways. For the ACA expansion populations, the ACA requires states to cover all FDA approved, granted, and cleared contraceptive methods, counseling on STIs and HIV, and screening for breast and cervical cancers. Research has found that most states have aligned their benefits and cover these services across all eligibility groups. - The federal government pays 90% of costs for family planning services, a higher federal matching rate than for other services (typically between 50% and 78%). Women covered by Medicaid cannot be charged any out-of-pocket costs for family planning services. - Federal law states that Medicaid beneficiaries have “free choice of provider,” which allows them to seek care from any qualified participating provider that offers the services. However, contrary to longstanding interpretation of the free choice of provider clause, a 2025 Supreme Court ruling, Medina v. Planned Parenthood South Atlantic, allows state Medicaid programs to disqualify clinics from participating in their networks if they offer abortion care in addition to other medical services. As of June 2026, at least seven states (AR, MO, MS, NE, OK, SC, and TX) have bans on Planned Parenthood’s participation in Medicaid, and several other states have proposed similar policies. Nationally, one in ten (10%) reproductive age women covered by Medicaid who received family planning services got their care at a Planned Parenthood clinic in 2023. - In addition to the Medina ruling, H.R.1 established a one-year ban on federal Medicaid reimbursements to Planned Parenthood in all states and some other reproductive health providers that provide abortion services. The policy was in effect from July 2025 to July 2026. While this rule expired, future legislation could be enacted by Congress to reinstate this funding ban. - Over half of states currently operate limited scope Medicaid family planning programs, which extend access to family planning services to uninsured women who do not qualify for full Medicaid coverage (often because their incomes exceed the Medicaid income thresholds). Maternity Care Medicaid is the largest single payer of pregnancy-related services, financing 40% of all U.S. births in 2024. In three states Medicaid covers more than 50% of all births. By federal law, all states provide Medicaid coverage without cost sharing for pregnancy-related services to pregnant people with incomes up to 138% of the federal poverty level (FPL), but many states extend eligibility to those at higher income levels. - Similar to family planning, there is no federal definition of what services states must cover under their traditional Medicaid programs for pregnant women beyond inpatient and outpatient hospital care, but states that have expanded Medicaid eligibility must cover all preventive services recommended by the United States Preventive Services Task Force (USPSTF) to individuals who qualify through this pathway, which includes a broad range of pregnancy-related preventive services. Overall, most states cover a broad range of maternity care services, including prenatal screenings, folic acid supplements, and breastfeeding supports. States may not charge cost-sharing for any pregnancy-related services. - Historically, Medicaid coverage for pregnant people ended after 60 days. Due in part to the high rates of maternal mortality and morbidity in the United States and the disproportionately high rates of poor maternal outcomes experienced by Black and Native American pregnant people, there was a growing interest in expanding postpartum coverage beyond the 60 days. The federal American Rescue Act of 2021 gave states the option to extend postpartum coverage to pregnant people to a full year. To date, all states, with the exception of Arkansas, have extended postpartum coverage to 12 months. - In the 10 states that have not expanded Medicaid coverage under the ACA, many women lose Medicaid eligibly after the postpartum period. This is because the income eligibility for pregnancy-related care is typically considerably higher than that offered to parents of dependent children. Eligibility levels for parents in the states that have not expanded Medicaid range from 15% FPL in Texas to 105% FPL in Tennessee (Figure 4). In the states that have expanded Medicaid eligibility, most women with Medicaid financed births are able to remain enrolled in the program and have continuous coverage beyond the postpartum period. Abortion While the 2022 Dobbs decision overturning Roe v. Wade eliminated federal protections and allowed states to ban or severely restrict the provision of abortion, abortion remains legal and available in many states. However, the federal Hyde Amendment prohibits federal spending on abortions in all states, except when the pregnancy is a result of rape or incest, or when it jeopardizes the life of the pregnant person (Figure 5). States may use their own unmatched funds to cover abortions in other circumstances. As of July 2026, 29 states (including the 13 states where abortion provision is currently banned) and DC follow Hyde restrictions and 21 states cover abortions for Medicaid beneficiaries that are considered to be “medically necessary” and pay for these using only state funds. Nearly half of women of reproductive age with Medicaid coverage live in a state that follows Hyde amendment standards or currently bans the provision of abortion. In cases when Medicaid finances abortions for Medicaid enrollees, reimbursement rates tend to be low and often do not cover the full cost of the procedure. Chronic Conditions As women age, their health needs generally shift from reproductive care to greater need for screening and management of chronic diseases, mental health care, and disability care (although many women in their reproductive years also have these health needs). Mental Health - In 2024, Medicaid covered over one in four (27%) adult women with any mental illness and 31% of adult women with a serious mental illness. - Medicaid’s behavioral health benefits include acute care services, long-term services and supports to enable people with chronic illness to receive community-based care. In addition, states with Medicaid expansion programs are required to cover 10 essential health benefits, which include mental health and substance use disorder services, including behavioral health treatment. Breast and Cervical Cancers - Under the Breast and Cervical Cancer Prevention and Treatment Act, states may extend Medicaid coverage for cancer treatment to uninsured women diagnosed with breast or cervical cancer through a federal screening program and receive a federal match for those services. In 2023, 44,000 women were enrolled in Medicaid through the Breast and Cervical Cancer Program. - Preventive services for breast and cervical cancers are required benefits in ACA Medicaid Expansion programs. States are required to cover mammograms and pap tests, genetic (BRCA) screening for high-risk women, and breast cancer preventive medication for high-risk women. Most states cover the screening tests for all beneficiaries. However, coverage for other services such as such as colposcopy following an abnormal pap result (which will be a required as a covered services under the HRSA Women’s Preventive Services Guidelines effective January 2027) and genetic screening for women at higher risk of breast cancer is more uneven across state eligibility pathways. Disability, Aging and Long-Term Care Women with Disabilities - Medicaid covers four in ten (41%) nonelderly women who have a broad range of physical and mental disabilities, including physical impairments, severe mental illnesses, and specific conditions such as muscular dystrophy, cystic fibrosis, and HIV/AIDS (Figure 6).3 In addition, Medicaid also covers some nonelderly women who separately also qualify for Medicare coverage due to long-term disabilities (discussed below). - Benefits that Medicaid covers include: assistance with medical and supportive services including rehabilitation, transportation, and therapeutic services, which help people with disabilities live independently and are not typically covered by private health insurance plans. Long-term services, including home health care, are another critical health benefit for women with disabilities that has very limited coverage through commercial plans but is covered by Medicaid. Medicare-Medicaid Enrollees and Long-Term Care Medicare provides health coverage to people 65 and older and younger people with long-term disabilities. Medicaid provides coverage to approximately 12 million Medicare beneficiaries (20% of all Medicare beneficiaries) with low incomes and modest assets. These individuals are often referred to as “dually eligible beneficiaries,” and in 2023, women of all ages accounted for 60% of this group (Figure 7). Many of these beneficiaries have extensive and costly health needs. - The majority of dually eligible beneficiaries qualify for full Medicaid benefits and may receive coverage for services that Medicare does not currently cover, such as dental and vision care, and long-term services and supports. Other dually eligible beneficiaries may only receive assistance with their Medicare premiums and/or cost sharing through the Medicare Savings Programs, but not full Medicaid benefits, if they meet an income and asset test. - Medicaid covers a continuum of long-term services and supports ranging from home care (HCBS) that allow persons to live independently in their own homes or in other community settings to institutional care provided in nursing facilities and intermediate care facilities for individuals with intellectual disabilities. In 2023, HCBS represented 64% of total Medicaid expenditures on long-term care (LTC). - Since women are more likely to live longer and experience higher rates of chronic illness and disability than men, they are more likely to require long-term services in their lifetime. Approximately two-thirds of nursing home residents (61%) and people receiving home health care (60%) are women. Medicaid coverage provides access to these long-term services, which would otherwise be unaffordable for women with fixed incomes (in 2025, nursing home care averaged more than $114,975 annually for a semi-private room). Access to Care Compared to their uninsured counterparts, women with Medicaid experience fewer barriers to care and on several measures have utilization rates comparable to low-income women with private insurance. - Women covered by Medicaid use primary and preventive health services, such as pap smears and mammograms, at rates comparable to women with private insurance and at higher rates than uninsured women (Figure 8). - Women with Medicaid coverage are less likely than uninsured women to experience cost barriers. Compared to low-income women with private insurance, women on Medicaid were less likely to report that they delayed or went without care due to cost, likely attributable to the fact that Medicaid does not charge deductibles, rarely charges premiums and has only nominal cost-sharing. Affordability, however, is still a problem for some women in the program because they are typically low-income and have to pay out of pocket costs in states that impose caps on the number of covered visits or prescriptions or charge copayments for prescription drugs (for non-pregnant adults). Three in 10 low-income women on Medicaid report that they had not filled a prescription (31%) in the past year because of the cost (Figure 9).