Vice President Kamala Harris (right) holds up a map depicting abortion access by state during the first meeting of the interagency Task Force on Reproductive Health on Aug. 3, 2022.
Patrick Semansky/AP Photo

State health officials say HHS could help by releasing a template or outline of what it would be willing to approve. Federal health officials counter that states should engage with them individually to develop solutions that fit their needs.

“We really need states to give us a little bit more info on what they would like. That’s coming through the various informal conversations that they’re having with CMS,”a secondsenior health official said. “But, ultimately, we need something from them in order to act and help expand access.”

If a waiver were approved, states would need to make sure low-income, out-of-state residents know the assistance is available and help them through the approval process — when states already struggle to reach their own Medicaid-eligible residents.

And any attempt to expand abortion access through Medicaid would almost certainly face legal challenges.

Vikki Wachino, former CMS deputy administrator in the Obama administration, said if federal health officials release guidance that’s too specific, states could be discouraged from exploring other innovative approaches.

She also noted the waiver process takes time and that states might be able to pursue their own state-level funding approaches in tandem with seeking authority through Medicaid.

“The guidance has been out a month. I can’t think of a time when the federal government put up a new opportunity and had state responses a month later. It takes some time just on the states’ part to figure out how they want to approach it. Do they want to move forward? What does it mean for them and their delivery system and their finances?” Wachino said. “I would give it some time.”