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Colorado restricts where Medicaid patients can get an abortion. Democrats want to end that.

Only individuals who experience rape, incest or a life-threatening pregnancy can get an abortion covered by Medicaid. But even then the list of facilities that can provide them is limited.

A Planned Parenthood clinic in Denver's Capitol Hill neighborhood. (Jesse Paul, The Colorado Sun)
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A group of Colorado Democrats want to make it easier for low-income people in Colorado who have experienced rape, incest or a life-threatening pregnancy to access abortions by eliminating state restrictions on the types of facilities where abortions are covered by Medicaid. 

“Every patient who is a survivor of rape or sexual assault has gone through so much already. So to put up barriers, that may be insurmountable for certain patients, is just not OK, and I don’t think Colorado as a whole wants that to be the way we deliver abortion care for sexual violence survivors,” said Kristina Tocce, medical director for Planned Parenthood of the Rocky Mountains. Planned Parenthood helped draft legislation that will be introduced during the legislative session that resumes next week. 

Nationwide, Medicaid patients cannot get an abortion covered unless their pregnancy is the result of a rape or incest, or if the pregnancy is life-threatening. Colorado has an added restriction that limits which facilities can provide an abortion. 

Abortion advocates say the number of facilities that can provide abortions covered by Medicaid is very small, but they aren’t exactly sure of the number. The Colorado Department of Public Health and Environment didn’t immediately know Tuesday how many facilities fall into that category.

But in practice, it means some patients must leave their home communities for care even if there are clinics, family doctors or women’s health practioners who provide abortions in their area. 

For that narrow group of people who can get an abortion covered by Medicaid — low-income survivors of sexual violence or people who have life-threatening pregnancies — access to an abortion can mean driving long distances to find the right provider.

“What it means is you’d have to be at a hospital, and most hospitals don’t even offer abortion care,” said state Sen. Brittany Pettersen, a Lakewood Democrat, who along with Sen. Kerry Donovan, a Vail Democrat, is a prime sponsor of the bill. 

Democrats control the state Senate and House, and Gov. Jared Polis is a Democrat. That gives the measure a strong chance at being signed into law.

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Colorado has few legal limits on access to abortions, and advocates say residents of states like Texas and Oklahoma have sought the procedure in Colorado because of restrictions in their own states. Nationwide, a policy known as the Hyde Amendment has banned federal funding for abortions since 1976, severely limiting options for people on Medicaid and other publicly funded programs. 

While 16 states currently use their own money to fund abortion care for individuals insured by Medicaid, Colorado voters narrowly passed a constitutional amendment in 1984 that prohibits public funding for abortions. The two exceptions are for Medicaid patients who have experienced rape, incest or life-endangering pregnancy, and for public employees, who can use public health plans to access abortions only if their life is endangered. 

That constitutional amendment can be repealed only through a voter-approved ballot measure. So advocates are focused on removing language enshrined in state statute that allow those Medicaid patients to have abortions covered only if they are performed at “a licensed health facility” with a physician performing the procedure. 

But the definition of what counts as a “licensed facility” essentially leaves out private doctor’s offices, clinics and number of other trained medical providers that already provide abortions for people covered by private insurance or who pay out-of-pocket, said Jack Teter, political director for Planned Parenthood in Colorado.

“It’s an extremely narrow limitation on low-income rape survivors. That’s basically the only people it applies to,” said Teter. “This restriction isn’t based in medicine – if it was, it wouldn’t only apply to rape survivors on Medicaid.”

Longtime anti-abortion activist Kristi Burton Brown declined to comment on the bill until its full text is released. Brown, who is vice chair of the Colorado GOP, said expanding abortion to “unlicensed facilities and [allowing] non-physicians to perform them” would increase risks for women. 

“Planned Parenthood should not be proposing a bill that puts women’s health and lives in danger while also attempting to end the lives of more children,” Brown said. 

Teter said the legislation would allow these Medicaid patients to access care already available to everyone else. 

“When the bill passes, those people will be able to obtain abortion care in a normal health care office, just like anyone else,” Teter said. “That could be their OB-GYN’s office (if that person provides abortion care), or an independent abortion provider’s office, or a Planned Parenthood, or a hospital if they want to – the places the rest of the population gets abortion care now.”

Tocce, Planned Parenthood’s medical director, said the restriction on what facility Medicaid patients can receive a covered abortion is also not widely known.

“I’ve had a patient say, ‘I can’t use my Medicaid? I went to the public health department and they told me I should go to the local Planned Parenthood,” Tocce said. “And after going through everything a survivor goes through, to be told you are at a place that can provide care, but you can’t use your insurance?”

Delays to getting an abortion can also increase barriers, said Amanda Carlson, director of the Cobalt Abortion Fund, which provides financial assistance for individuals seeking abortions. 

Most abortion procedures happen in the first trimester, and can cost from $375 to $600, depending on the type of provider, Carlson said. Individuals might also delay an abortion while they try to get the money to pay for it, and as pregnancy progresses, costs can increase and may reach into five figures. 

It’s difficult to tell how many people are affected by the restrictions. Some providers, including Planned Parenthood, have funding set aside for people with financial difficulties or other barriers. 

Carlson said the Cobalt fund gets a request for assistance “every couple of weeks” from a person who says Medicaid won’t cover their abortion. 

The fund, which issues vouchers to help pay for the cost of abortion care, doesn’t have an income requirement and relies on volunteered information from applicants. 

“While there are a lot of abortion clinics in Colorado, we’ve had several clients who have to drive, like if you live in Grand Junction, they often have to drive to Glenwood Springs to get an abortion,” Carlson said. “We have a higher level of access than other states, but we still see folks who are having to put together gas money to travel and secure reliable transportation to a clinic.”

Independent clinics and doctors don’t always advertise that they provide abortions because of concerns about retaliation and protests. Carlson believes some of the fund’s clients on the Western Slope and other rural areas end up driving long distances because they don’t realize they could get assistance to have an abortion closer to home. 

“For someone who is pregnant and is just trying to access care as fast as they can, people might end up traveling farther than they need to,” Carlson said. 


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