Written by: Lindsey Grater, MS4 at the Medical College of Georgia
Key Takeaways
While most individuals with intellectual and developmental disabilities (IDD) in Georgia qualify for Medicaid, OB/GYN access remains limited. Gaps stem not from a lack of coverage, but from structural issues in how services are prioritized, coordinated, and delivered, especially through Georgia’s 1915(c) waiver programs and EPSDT. These systemic failures leave many patients with IDD without routine reproductive healthcare.
Introduction
Accessing quality health care is already challenging for many Georgians, but for individuals with intellectual and developmental disabilities (IDD), those challenges are even greater. While most people with IDD in Georgia qualify for Medicaid, basic reproductive and OB/GYN services often remain out of reach—not because coverage doesn’t exist, but because the system isn’t built to prioritize or coordinate this kind of care. As a result, too many individuals with IDD are left without the preventive screenings, menstrual health management, or reproductive care that others may take for granted.
This article takes a closer look at how Georgia’s Medicaid waivers and EPSDT policies impact access to OB/GYN care, where the biggest barriers exist, and what providers, caregivers, and advocates can do to close the gap.
Medicaid Waivers in Georgia: Coverage vs. Access
Georgia operates two major 1915(c) Medicaid waivers for individuals with IDD:
– NOW (New Options Waiver)
– COMP (Comprehensive Supports Waiver)
These waivers provide essential nonmedical supports like personal care assistance, supported employment, and respite care. However, they do not include OB/GYN services in their goals or required offerings. Each participant works with a support coordinator to create an annual service plan focused on daily living, behavior, and employment goals, not preventive or reproductive healthcare.
Impact: While OB/GYN services are technically covered under standard Medicaid, they are rarely addressed in waiver service plans. Because of this, there is no built-in structure to ensure these services are scheduled and accessed.
EPSDT: Underused for Reproductive Health in Adolescents with IDD
EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is a federal requirement for all Medicaid enrollees under 21. It mandates coverage of preventive services, including gynecologic screening and STI testing when medically necessary.
You can view Georgia’s EPSDT policy here.
In Georgia:
– EPSDT is inconsistently applied:
– In 2019, fewer than 30,000 of Georgia’s 1.4 million EPSDT-eligible children received referrals for care, placing Georgia among the lowest-performing states in follow-up action (1).
– Caregivers often lack guidance on using EPSDT for reproductive care.
– OB/GYN providers may have limited training or experience in caring for youth with disabilities.
Impact: Reproductive health concerns like menstrual management or contraceptive counseling are often neglected entirely in adolescents with IDD.
- Georgia-Specific Barriers and Initiatives
A. Guardianship Laws
In Georgia, full legal guardianship grants broad authority over medical decision-making, including reproductive care. This can limit the autonomy of individuals with IDD, particularly when guardians are not aware of, or do not prioritize, reproductive health needs.
Link: O.C.G.A. § 29-4-21
B. Provider Training Gaps
Georgia does not require disability-specific CME, and most OB/GYNs receive no formal training in IDD care.
-Nationally, only 17.2% of OB/GYNs report any training in caring for women with disabilities, and fewer than 20% feel prepared to manage their reproductive care (2).
-Georgia DPH’s reproductive health resources do not address disability (DPH).
C. Reproductive Health Initiatives by Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD)
-In 2024, DBHDD launched a Reproductive System Management Healthcare Plan as part of its Health and Wellness Initiative.
-The plan provides optional tools for identifying reproductive health needs, recommending screenings, and promoting preventive OB/GYN care for individuals receiving NOW/COMP waiver services.
-However, participation is not required, and access to these resources remains limited across Georgia.
Link to DBHDD: Improving Health Outcomes Initiative
- What Can We Do?
For OB/GYNs and Primary Care Providers:
– Initiate the conversation. Ask about menstrual health, sexual health, and contraception needs. Ask about guardianship status early.
– Use disability-informed approaches. Adapt consent forms, exams for sensory needs, allow extra time, and use communication aids.
– Seek training opportunities:
• Baylor CME: Adapting Primary Care visits for Youth and Adults with IDD
-Not OB/GYN-specific, but Baylor has previously offered gynecologic health modules for patients with IDD.
• ACOG Committee Opinion: Health Care for Women with Disabilities(practical guide for OB/GYN providers).
• IDD Toolkit: tips on communication, preventive screening, and reproductive care.
For Waiver Support Coordinators:
– Add reproductive health to service plans.
– Assist with logistics: schedule appointments, provide pre-visit education.
For Caregivers and Guardians:
– Support reproductive autonomy and preventive care.
– Know what’s covered under Medicaid and EPSDT.
Conclusion
Reproductive health is an essential part of overall well-being, yet for far too many Georgians with IDD, it remains overlooked. The gaps in Medicaid coordination, provider training, and waiver support create unnecessary barriers that impact both quality of life and long-term health outcomes.
At The Arc Macon, we believe equitable access to care is a matter of dignity and human rights. We are committed to raising awareness, supporting families, and partnering with providers to ensure that individuals with IDD have the same opportunities for preventive and reproductive health care as anyone else.
Together, we can create a system that not only covers reproductive health, but makes sure it is truly accessible.
References
(1) Miller A. Bottlenecks in Medicaid: Kids Get Screenings — but Not Always the Referrals for Care. Georgia Health News. July 21, 2021. Accessed August 5, 2025. https://www.georgiahealthnews.com/2021/07/bottlenecks-medicaid-kids-referrals-care/
(2) Access to obstetric and gynecologic care for patients with disabilities. Committee Statement No. 18. American College of Obstetricians and Gynecologists. Obstet Gynecol 2025;145:553–563.