Action Steps

1. Learn about your state’s policy details.

Individual states implement the Medicaid sterilization policy differently, as Medicaid is federally-mandated but administered by states. Information pertaining to each state’s Medicaid sterilization policy is accessible online on the state Medicaid office’s website for 48 out of 50 states (not CT or DE).

State policy details can be viewed here:

2. Work with your state Medicaid office to develop a toolkit.

Toolkits are helpful resources for understanding your state’s policy, improving transparency, and ensuring that consent forms are filled out appropriately. For examplary toolkits, view the guidelines developed by Massachusetts and Tennessee Medicaid offices:

3. Involve community members in federal Medicaid policy revision.

The bioethical complexities of the Medicaid sterilization policy warrant that the goals and priorities of patients are at the center of policy revision. Thus, it is critical that community conversation is the driver of recommendations. For instance, the Coalition to Expand Contraceptive Access (CECA) formulated a policy brief based on two expert workgroup meetings and two Lived Experience Panels of community members to provide input on revisions. The CECA ultimately presented the six following recommendations:

1. Lower the minimum age of consent from 21 to 18 years old.
2. Remove the prohibition on people consenting to sterilization when seeking to obtain or obtaining an abortion.
3. Change the consent form expiration period from 180 days to 365 days.
4. Change the required waiting period between an individual’s signature on the consent form and the date upon which the sterilization is performed from 30 days to 72 hours.
5. Evaluate how to best collect and utilize race/ethnicity data.
6. Incorporate supported decision making into the federal sterilization consent process and provide needed resources for implementation.