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Proposed rules for Medicaid funding for abortion providers: What to know

JEFFERSON CITY, Mo. — Regulatory and statutory changes to the state’s Medicaid system may be on the way based on proposals from a Senate committee tasked with evaluating abortion funding

One proposal would see the Missouri departments of Health and Senior Services (DHSS) and Social Services (DSS) work together on expanding standards on Medicaid funding for abortion providers and increase sanctions for noncompliance. Under the drafted regulatory changes, DSS would consider revoking or denying licenses based on DHSS reports rather than having to conduct its own investigation. 

The report from Sen. Bill White, who chairs the Senate Interim Committee on Medicaid Accountability and Taxpayer Protection, recommended the departments draft emergency rules and put them into effect as soon as possible.

A statutory proposal would allow the departments to deny or revoke Medicaid funding for abortion providers or connected entities found to have violated regulations in other states and facing sanctions or termination. Offenses would include failure to keep up with reporting requirements, health code violations, and failure to cooperate with state investigations. 

The committee convened Thursday to discuss the draft of recommendations compiled throughout the summer based on testimony from the public and both departments. The changes were proposed to enforce the state’s commitment to “protecting an unborn child through pregnancy and ensuring respect for all human life,” according to the report. 

Members are expected to sign off on the draft in the coming days. If the report is approved by the committee, the first proposal would be sent to the departments for consideration. The second proposal, related to offenses in other states, would need to pass through the full legislature. 


Few Republicans sounded off on the recommendations Thursday — though White voiced his support for a more streamlined certification and revocation process and an update to Missouri’s standards. He said the details of the changes would ultimately be up to the departments. 

“We’re asking them to be more vigilant and to review and intensify what they’re looking at, but we’re not changing how they’re analyzing their data,” White said. “This report isn’t giving them any orders to analyze things differently. We’re saying we want more criteria, and we want it to be more diligent. This is our report to them in English that they will then convert into rules.”

White noted the changes would not impact Planned Parenthood specifically but apply to any abortion provider or affiliate in the state; the group’s St. Louis clinic is Missouri’s sole abortion provider. 

Sen. Karla Eslinger questioned whether issues in other states that had been resolved could still impact funding. White said that would need to be determined as that proposed change moves through the legislative process. 


Democratic Sens. Lauren Arthur and Jill Schupp expressed concerns over the proposals, with Arthur questioning the intent of the suggestions and pointing to broader implications the changes could have on health care providers and patients. 

“If this is a backward attempt to defund Planned Parenthood, I worry about the impact that would have on health care access,” Arthur said. “It doesn’t seem like there’s a solution for who would fill that gap, and I think there’s some ambiguity in the language and haven’t received confirmation that if this were to go into effect we wouldn’t jeopardize our Medicaid funding.”

Schupp warned of a potential chilling effect and gap in coverage for Planned Parenthood patients while complaints are investigated, an issue she said has impacted patients in the past. 

The committee was established this summer following the standoff over the state’s federal reimbursement allowance (FRA), which collects a tax from health care providers and matches the funds to pay for the MO HealthNet program. Senate leadership formed the committee to address the concerns of a band of conservative members who opposed the use of Medicaid funds for abortion providers and draft recommendations to continue the “protection of unborn life” in the state.

The committee is required to file another report covering transparency issues by the end of the year. The next hearing is scheduled for Oct. 4.