2024 State Policy Roundup: Major Victories In Expanding Abortion Coverage
The abortion access landscape has undergone significant changes in the year
2024. States that are hostile to abortion have increased their restrictions, while states that support reproductive freedom have done the exact opposite. This has further cemented the fact that where you live can often determine your ability to get abortion care. We have seen many harmful policies passed in the last year, but we also saw important progress in states that are committed to expanding and improving comprehensive coverage of abortions, especially for Medicaid enrollees. This blog will recap the major changes at the state level, including new coverage mandates for Medicaid enrollees and in private plans, cost-sharing prohibitions, and other efforts to improve access.
Coverage Expansions
Medicaid Coverage
2024 saw substantial changes in the landscape for abortion coverage in Medicaid. Delaware became the newest state to enact Medicaid coverage of abortion via legislation. This new law covers abortion services up to $750 per enrollee, per year without any cost sharing requirements. It is scheduled for implementation in January of 2025. While this policy could be improved by removing the benefit cap, this new coverage mandate is a huge win for Medicaid enrollees in Delaware.
Nevada is in the process of implementing coverage of abortion for Medicaid enrollees as the result of litigation challenging the state’s funding ban under the Equal Rights Amendment in Nevada’s constitution. In September, a Nevada court issued a final written order instructing the Division of Health Care Financing and Policy to remove the prohibition and implement coverage for Nevada Medicaid enrollees.
Finally, in November Colorado voters approved Amendment 79, which enshrines protections for abortion access in the state constitution. These protections include the repeal of the state’s long-standing prohibition on public financing for abortion coverage. The necessary policy changes are now being made to implement comprehensive coverage. Colorado already mandates abortion coverage in private individual and group plans thanks to a 2023 law, so the success of the ballot measure means that no Coloradan will be denied care because of their type of insurance.
While implementation is ongoing for all three states, it is incredibly exciting to see three states on the precipice of joining the 17 that use their own funding to provide abortion coverage. Comprehensive coverage of abortion for Medicaid enrollees is one of the most important factors in building an equitable abortion access landscape, as it improves access and distribution of abortion fund resources to low income and underserved populations.
Private Coverage
Minnesota became the newest state to mandate abortion coverage in all individual and group plans issued in the state. The law also amends the existing statute so that abortion services are not excluded from protections which allow an enrollee to choose their provider when seeking family planning services. It will go into effect in January 2025. It will go into effect January2025.
Minnesota also updated the statutory language requiring abortion coverage for Medicaid enrollees, removing language about medical necessity and making it clear that the state’s Medicaid program covers all abortions and abortion-related services for enrollees.
Coverage Improvements
Cost-Sharing Prohibitions
Similar to years past, we saw states with abortion coverage mandates seek to eliminate financial barriers by prohibiting cost-sharing requirements for abortion seekers. As a part of a broader birth equity bill, Illinois updated its abortion coverage statute to prohibit all cost-sharing limitations for abortion services. Before this law, insurers were allowed to implement cost-sharing obligations on abortion services, as long as the costs did not exceed those for pregnancy-related services. The average deductible of an employee-sponsored insurance plan is $2000. However, the cost of abortion can vary from $500 to over $1000. The average person would have to pay for their abortion out of their own pocket if they did not reach their deductible. This type of out-of pocket cost can be devastating for people with low-incomes, or force them to spend time trying to collect the money they need to cover their care. This may push them further into pregnancy and escalate the costs. Eliminating out-of-pocket costs for people seeking an abortion is a crucial step toward ensuring all people can access abortion, regardless of their income.
Uncompensated Care Funding
The post-Dobbs data is clear – abortion restrictions are forcing more people to travel to access care and those travel distances (and associated costs) are increasing. People who are forced to travel, and especially Medicaid enrollees, cannot use their insurance for payment. As a result, states, such as
California, Oregon, and Massachusetts, have created uncompensated care funds in the last few years. These programs reimburse providers for the care of patients who do not have insurance or cannot use it. This year, New York State enacted the Reproductive Freedom and Equity Grant program in its final budget, which provides funding to providers and abortion funds to build provider capacity and fund uncompensated care.Conclusion
The abortion access landscape continued to shift rapidly in 2024, and 2025 will likely present even more challenges as the new Congress and Trump Administration take control of the federal levers of power. The states have been at the forefront in protecting and expanding access to abortion, including efforts to establish comprehensive coverage. The policies highlighted in this post are crucial to creating an equitable abortion landscape, and these victories should be celebrated. Cat Duffy (
) is the National Health Law Program’s dedicated advocate for state advocates on abortion coverage and reimbursement. If you have any questions, or need technical support, please contact her at ([email protected]).
