State Funding of Certain Abortions

Public funds may be used for abortion services in Virginia under the following circumstances:

  • 32.1-92.1. Funding of certain abortions where pregnancy results from rape or incest.
  • 32.1-92.2. Funding of certain abortions where fetus is believed to have incapacitating physical deformity or mental deficiency; physician’s certificate.
  • Cases where the pregnancy threatens the life or health of the mother/birthing person.

The Virginia Department of Health (VDH) may use state funds for patients with Medicaid when they have 1) experienced rape or incest and have followed reporting requirements outlined by law, or 2) have a fetus with a documented incapacitating abnormality. The Virginia Department of Medical Assistance Services (DMAS), Virginia’s Medicaid Program, may use public funds for patients with Medicaid in cases where the pregnancy threatens the life or health of the mother/birthing person.

This page includes information for providers about applying for funding in cases rape/incest or fetal anomalies. For cases involving endangerment of the mother/birthing person’s life, contact DMAS (Medicaid) for assistance.

Do NOT fill out the application below for cases involving endangerment of the mother/birthing person’s life. Contact DMAS instead.

Application Form

For more information, contact reproductivehealth@vdh.virginia.gov.

FAQs for Providers

What are the patient eligibility requirements?

The patient must be a Virginia resident, meet the financial eligibility criteria of the Virginia Department of Medical Assistance Services Plan (Medicaid), and meet one of the two criteria outlined in the Code of Virginia:

  • 32.1-92.1. Funding of certain abortions where pregnancy results from rape or incest.
  • 32.1-92.2. Funding of certain abortions where fetus is believed to have incapacitating physical deformity or mental deficiency; physician’s certificate.

What documentation is required to meet the Intent of the Law/have an application approved? 

  • An application form (SFA-12) completed by a Certifying Physician and submitted to the Virginia Department of Health prior to the procedure or within the three months after the procedure.
  • Rape or incest cases must be reported to law enforcement, a Virginia Department of Health local health district office in the locality where the patient resides, or the Virginia Department of Health state office.
  • Cases of gross and totally incapacitating physical deformity or mental deficiency of the fetus must be certified as such by a physician who has performed medically appropriate tests to support the assessment. VDH requires copies of cited evidence including but not limited to ultrasound, amniocentesis, or blood work.
  • In order to demonstrate proof of financial eligibility, the application must include a copy of the patient’s Medicaid card, a copy of the patient’s Medicaid HMO card, the patient’s Medicaid card number, OR documented verification from a certified Medicaid eligibility specialist that the patient’s income meets the Virginia Medicaid financial eligibility screening criteria.

*VDH reserves the right to request additional information in order to determine eligibility for funding.

My application was denied approval, and I think it was a mistake. What are my options?  

An appeal may be submitted in writing to VDH within five business days.  The appeal must be in writing and should be faxed to (804) 864-7771 and clearly state the grounds upon which the applicant believes the request meets the criteria of Code of Virginia § 32.1-92.1 or § 32.1-92.2. The final decision will be made by VDH’s Deputy Director of Population Health or his/her designee and communicated in writing and by phone to the applicant within two business days of appeal receipt.

How does my facility get reimbursed?

Reimbursements are made in accordance with the Virginia Public Procurement Act, including prompt payment provisions.

To receive payment, the facility and physician performing the abortion must submit a CMS 1500 Health Insurance Claim Form to:

Reproductive Health Unit
Virginia Department of Health
PO Box 2448
109 Governor St.
Richmond, VA 23219

  1. Billing codes must reflect the approved procedures performed.
  2. Payment shall be limited to the Medicaid allowable rate for the procedure.
  3. Payment shall constitute full and final payment for such services.
  4. The Department reserves the right to refuse payment if the following occur:
    • The invoice is over one year from the date of the procedure, or
    • The procedure was not pre-approved.

What if my payment is denied?  Payment may be denied if it is determined that there was a violation of applicable state and federal laws and regulations.

What if the mother’s life is endangered?  For cases involving endangerment of the mother’s life, contact DMAS (Medicaid) for assistance. The Virginia Department of Health does not appropriate funds for abortion services unless they meet the requirements outlined by state law. See the Patient Eligibility Requirements listed above.

What if a patient meets the eligibility requirements for State Funding for Certain Abortions, but the procedure has already happened? Funding applications may be submitted within three months after the procedure has occurred. Applications received after three months will not be considered.

Definitions

  • Certifying Physician: Physician, who holds a current license to practice medicine in the state of Virginia that has conducted a physical examination and appropriate tests of the applicant and based on this examination is able to certify the gestational age of the fetus and the presence of a gross and totally incapacitating physical deformity or mental deficiency.
  • Incest: Incest as defined in the Code of Virginia 18.2-366 means a person who commits adultery or fornication with any person whom he or she is forbidden by law to marry.
  • Patient Applicant: Patient requesting payment for abortion services under Code of Virginia 32.1-92.1; Code of Virginia § 32.1-92.2.
  • Providers of Abortion Services: A general hospital or other provider that is providing abortion services for the Patient Applicant.
  • Rape: If any person has sexual intercourse with a complaining witness, whether or not his or her spouse, or causes a complaining witness, whether or not his or her spouse, to engage in sexual intercourse with any other person and such act is accomplished (i) against the complaining witness’s will, by force, threat or intimidation of or against the complaining witness or another person; or (ii) through the use of the complaining witness’s mental incapacity or physical helplessness; or (iii) with a child under age 13 as the victim, he or she shall be guilty of rape. (Code of Virginia 18.2-61).