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    v1.0.28
    OpenPayerPolicy UpdatesObstetrics/GynecologyAlaska Medicaid abortion coverage criteria | OpenP…
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    CurrentAlaska MedicaidPolicy N/A

    Certificate to Request Funds for Abortion

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    Form and procedure for requesting Alaska Medicaid funds to pay for abortions that are not covered by federal Medicaid, applicable to Alaska Medicaid providers and patients when abortions are medically necessary or due to rape/incest.

    Policy Summary
    PayerAlaska Medicaid
    PolicyCertificate to Request Funds for Abortion
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 2001
    Next Review DateN/A
    Key ActionSubmit a completed and signed physician certificate to Alaska Medicaid Medical Review to request state funding when federal Medicaid does not cover the abortion.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2grounds for funded abortion
    3submission methods
    2001Supreme Court order year

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Coverage Criteria

    Funded Abortion Criteria

    Alaska Medicaid may pay for abortions that federal Medicaid does not cover when ONE of the following is certified:

    Funded Abortion Criteria: (1) Pregnancy resulted from an act of rape or incest; OR (2) Physician certifies that the patient has a physical disorder, physical injury, or physical illness, including a life‑endangering physical condition caused by or arising from the pregnancy that would place the woman in danger of death unless an abortion is performed; OR (3) The abortion was medically necessary.

    Certification must be documented on the completed and signed certificate.

    Elective abortions that do not meet the policy’s stated indications are not covered by federal Medicaid. Under a 2001 State Supreme Court order, Alaska Medicaid may, in specified circumstances, provide funding when the abortion is not covered federally. However, such state funding is only considered when one of the authorized certifications applies (see criteria), and elective procedures that do not meet those criteria remain outside federal coverage.

    If the abortion is elective and does not meet the certified grounds in this policy, it is not eligible for Alaska Medicaid payment. State funding consideration is limited to cases that satisfy the documented criteria (rape or incest, or physician certification of a qualifying physical disorder/injury/illness), or where the abortion is otherwise medically necessary as certified on the required form.

    Coding

    No codes listed in documentmixed
    No codes listed
    Coding thresholds
    Thresholds specifiedNo thresholds specified in the document

    Provider Actions & Submission

    Prior Authorization

    Submit completed certificate to Alaska Medicaid Medical Review

    If the abortion is medically necessary and not covered by federal Medicaid, submit the completed Certificate to Alaska Medicaid Medical Review so the program can determine the proper source of payment. Submission may be by the specified email for healtheConnect Alaska providers or by mail to the Division of Health Care Services Medical Review address.

    • Submit completed certificate to Operations.MedicalReview@hss.soa.directak.net (for providers with a healtheConnect Alaska account).
    • Mail completed certificate to: Alaska Division of Health Care Services, Attention: Medical Review, 4601 Business Park Blvd., Bldg. K, Anchorage, AK 99503-7167.
    Note

    Use and submit the official certificate form

    The completed certificate must be used to document the physician's certification and permit the program to determine funding; follow the submission methods listed on the form.

    • Use the form text certifying rape/incest or medically necessary indications as the official attestation.

    Background

    Alaska Medicaid may pay for abortions that federal Medicaid does not cover when ONE of the following is certified: (1) the pregnancy resulted from an act of rape or incest; (2) a physician certifies the patient has a physical disorder, injury, or illness (including a life‑endangering condition caused by the pregnancy) that would place the woman in danger of death unless an abortion is performed; or (3) the abortion was medically necessary. This authority derives from a 2001 order of the Alaska Supreme Court and is documented via the completed and signed certificate required by the program.

    Definitions

    Medically necessary abortion — definition
    DefinitionAn abortion performed because a woman suffers from a physical disorder, physical injury, or physical illness — including a life‑endangering physical condition caused by or arising from the pregnancy that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.
    Certification requirementPhysician must certify the condition on the completed and signed certificate.
    Related circumstanceAlaska Medicaid may fund abortions not covered by federal Medicaid when the abortion is medically necessary or the pregnancy resulted from rape or incest.
    Legal contextFunding is provided under certain circumstances in accordance with a 2001 order of the Supreme Court of the State of Alaska.
    Policy Summary
    PayerAlaska Medicaid
    PolicyCertificate to Request Funds for Abortion
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 2001
    Next Review DateN/A
    Key ActionSubmit a completed and signed physician certificate to Alaska Medicaid Medical Review to request state funding when federal Medicaid does not cover the abortion.
    SourceLink
    On This Page
    Coverage CriteriaCodingProvider Actions & SubmissionBackgroundDefinitions
  1. Follow the form's listed submission options (email or mail) to send the completed certificate.
    2. Documentation Required

    Complete physician attestation certifying rape/incest or qualifying physical condition

    Complete and sign the physician attestation certifying that the pregnancy resulted from rape or incest, or that the patient has a qualifying physical disorder, injury, or illness (including a life‑endangering condition caused by the pregnancy), or that the abortion was medically necessary.

    • Check the applicable certification box on the form that matches the clinical indication.
    • Ensure the attestation reflects assessment based on all available information.
    Documentation Required

    Include physician signature and date; submit to Medical Review

    The certificate must include the physician's signature and date, and the completed and signed form must be submitted to the Alaska Division of Health Care Services Medical Review by the methods listed on the form.

    • Ensure physician (M.D. or D.O.) signature appears on the certificate.
    • Include the signature date on the form before submission.
    Denial Risk

    Risk of ineligibility for elective abortions

    Alaska Medicaid funding is available only when one of the certified indications is met: pregnancy from rape or incest, physician‑certified qualifying physical disorder/injury/illness (including life‑threatening conditions), or when the abortion was medically necessary; elective abortions that do not meet these criteria are not eligible for state payment.

    • Do not expect state funding for elective abortions that do not meet the certified criteria.