Does Medicaid Cover Tubal Ligation Reversals?

Does Medicaid Cover Tubal Ligation Reversals?
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Medicaid is government-provided health insurance for people who can’t afford insurance on their own. It’s available to low-income individuals and to families who meet certain eligibility requirements. Payments are made directly to health care providers and sometimes a small copay is required from the patient.

How Medicaid Works

Though the program is funded by the federal government, it is administered a little differently by each state. This means that each state can set its own guidelines defining who is eligible and what services are provided. Many states also fund their own Medicaid programs for low-income individuals and families who do not meet the federal eligibility requirements.

Tubal Ligations

Tubal ligation is a permanent form of birth control in a woman. It is a surgical procedure that involves having the fallopian tubes tied off. This interrupts the pathway between the ovaries and uterus. Eggs leave the ovaries and travel down the fallopian tubes where they can be fertilized in the uterus. With the tubes are tied off, conception will not occur.

Reverse Tubal Ligations

Sometimes a woman who has had this procedure done will change her mind. Perhaps she has divorced and remarried and wants to start a family with her new husband. In these cases, a tubal ligation can sometimes be reversed with surgery. The surgeon reattaches the fallopian tubes and places an implant in them so there is once again a passable pathway for the eggs.

Medicaid and Tubal Ligations

The cost of a reverse tubal ligation can run between $5,000 and $10,000 usually. Medicaid will sometimes cover tubal ligation or at least a portion of the cost as a method of birth control, but it will depend on what state the woman resides in. Some states will only cover the cost if the woman has given birth at least twice before or has been pregnant at least three times. There will also probably be a 30-day waiting period.

Medicaid and Reverse Tubal Ligations

Reverse tubal ligation is not usually covered by Medicaid. As late as 1996, New York Medicaid, which is the most expensive system in the country, would cover the procedure, but many other states will not. See the Resources section for a link to other state's Medicaid rules.