When Taylor Merendo moved to Bloomington, Ind., nearly two years ago, fleeing an abusive marriage, she needed help.
鈥淚 was six months pregnant and, at that point in time, I really didn鈥檛 have a stable place to live,鈥� Merendo said.
That鈥檚 where the聽聽in Bloomington stepped in. It鈥檚 what鈥檚 known as a crisis pregnancy center, where women are counseled against abortion and often get support after their babies are born.
Many low-income women come in believing they need to have an abortion, says Executive Director聽, and she tries to persuade them otherwise.
鈥淏ecause for many women it鈥檚 not truly a choice when they feel like they don鈥檛 have any other options,鈥� she said.
Women鈥檚 health has been the center of a lot of controversy in the ongoing health care debate, and much has focused on federal聽. While federal funding for abortion is already illegal in most cases, many abortion-rights opponents also want to permanently block Planned Parenthood from receiving federal reimbursement for providing services like contraception.
As it turns out, many crisis pregnancy centers like the Hannah Center, alternatively known as pregnancy resource centers, also rely on Medicaid as a tool for helping low-income pregnant women.
The nonprofit organization housed Merendo for about a year in its聽聽and helped her apply for Medicaid in Indiana. Low-income pregnant women qualify in every state, though exact income requirements vary by state.
Now 21, Merendo is caring for her 19-month-old son and training to become a nursing assistant. She said she never wanted an abortion, but she couldn鈥檛 have afforded her prenatal visits, let alone the delivery, on her own.
鈥淚f Medicaid wouldn鈥檛 have paid for it, it would have been thousands of dollars,鈥� she said. 鈥淎nd being a single mother, you really just can鈥檛 鈥� can鈥檛 pay for that.鈥�
A lot of women can鈥檛. For pregnant women in the United States, Medicaid is less a safety net than a building block of the maternity care system.
Of the 4.3 million births in the United States each year, more than 2 million are covered by Medicaid 鈥� nearly half. The program covers not only delivery, but also prenatal and some postpartum visits, as well as infant care.
For the Hannah Center in Indiana, at least 90 percent of clients receive Medicaid. Directors of several similar organizations interviewed by NPR indicated that most of their clients also do. An NPR review found at least two dozen such centers advertising online that they offer Medicaid referrals or enrollment assistance.
Andrea Krazeise runs the聽聽near Orlando, Fla., which provides free pregnancy tests and paperwork to verify a positive result.
鈥淭hat鈥檚 the primary service that every pregnancy center offers 鈥� the proof of pregnancy,鈥� Krazeise said.
Without Medicaid, Krazeise said, many of her clients likely wouldn鈥檛 see a doctor until the very end of the pregnancy.
鈥淪he would go to the emergency room or she would have no care, and then when her water breaks and she鈥檚 about to go into labor, then she鈥檒l be in the emergency room,鈥� she said.
础迟听聽in Metairie, La., Michelle Black works with clients like Tara Lang, 28, of Jefferson Parish, whose daughter was born in January. She turned to Medicaid after her fianc茅, who鈥檇 been providing her health insurance, was killed in a motorcycle crash by a drunken driver while she was pregnant.
鈥淢y world turned upside down completely, like literally in five seconds,鈥� Lang said.
Medicaid has been聽聽under recent聽聽in Congress. Black said she worries that might in turn push states to slash reimbursements to physicians. She said such cuts would hurt the maternity clinic her organization also runs, and make it harder for pregnant women to find doctors.
鈥淚 mean it鈥檚 a major concern,鈥� Black said. 鈥淲e鈥檝e actually seen fluctuations in the amount of money that we get reimbursed through the clinic, and I know the doctor offices are seeing that as well. So in some cases people who have accepted Medicaid in the past aren鈥檛, because the reimbursements have shrunk,鈥� she said. 鈥淪o we鈥檝e been watching a whole lot of things; we know that it鈥檚 affecting our clients.鈥�
There鈥檚 a danger that patients will struggle to find care if reimbursement rates are cut, said聽, executive director of the National Association of Medicaid Directors, which represents directors of state programs.
鈥淚f you precipitously drop what we pay, then what you鈥檙e gonna end up with is a scenario where the Medicaid insurance card is kind of like a hunting license,鈥� Salo said. 鈥淵es, you have coverage 鈥� but good luck finding someone who鈥檚 gonna be willing to take pennies on the dollar to treat you.鈥�
Women鈥檚 health groups like the聽note that uninsured women have higher rates of pregnancy complications, including preterm birth. CEO聽聽said those women also have a harder time planning future pregnancies because of reduced access to contraception.
鈥淎nd so they have a higher incidence of unintended pregnancy,鈥� he said.
At her pregnancy center in Indiana, Tuley-Lampke said she has occasionally caught flak from conservative donors for helping women enroll in government services.
鈥淭hey鈥檒l say something like, you know, 鈥楽houldn鈥檛 your job be to get people off of government services, and not on government services?鈥� I think that鈥檚 definitely the goal,鈥� she said. But that can鈥檛 always be the goal, Tuley-Lampke said, when you have a lower-income single mom who either doesn鈥檛 have a job or, if she does have a job, it earns minimum wage or less.
But Tuley-Lampke said she鈥檚 seen several women decide to continue their pregnancies after learning that their medical care would be provided. After pregnant women get basic health care, she said, they can then focus on their education and career.
鈥淪ometimes simply explaining to them, we can help them through the process of obtaining Medicaid, is all it takes for them to realize, you know, 鈥業 can do this; I can be a mom,鈥� 鈥� Tuley-Lampke said. 鈥淎nd so it is very ironic to me that people who are pro-life would not also be pro-Medicaid.鈥�
This story is part of a partnership that includes and Kaiser Health News.