2024 was yet another year of significant change for the abortion access landscape. States hostile to abortion have doubled down on increasingly extreme restrictions while states committed to reproductive freedom have done the opposite, further entrenching the reality that where you live often determines your ability to access abortion care. While we saw many harmful policies enacted in the past year, we have continued to see important progress in states dedicated to expanding and improving comprehensive insurance coverage of abortion, particularly 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 provides coverage of abortion services (up to $750 per enrollee per year) without any cost-sharing requirements and is slated for implementation in January 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 repealing the state’s longstanding prohibition on public funding for abortion coverage. Work is now underway to make the necessary policy changes to implement comprehensive abortion 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 existing statute to ensure abortion services aren’t excluded from protections that allow an enrollee free choice of provider when seeking services related to family planning. Additionally, it prohibits health plans from imposing prior authorization and other limitations that delay care, which is crucial for the time-sensitive nature of abortion care. 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. Prior to this law, insurers could implement cost-sharing obligations for abortion services as long as they did not exceed those required for pregnancy-related care.
These prohibitions mean that an individual seeking an abortion cannot be required to pay a co-payment or forced to meet their deductible in order to have their services covered. The average deductible for an individual with employer-sponsored insurance is around $2000, while the typical cost for abortion can range anywhere from $500 to well over $1000. That means the average person would essentially have to pay out of pocket for their abortion if they were not close to hitting their deductible. This kind of out-of-pocket cost can be catastrophic for people with low incomes or may force people to spend time collecting the money they need to pay for their care, pushing them further into their pregnancy and escalating 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. Often people who are forced to travel cannot use their insurance to pay for care, especially Medicaid enrollees. As a result, states, such as California, Oregon, and Massachusetts, have created uncompensated care funds in the last few years. These programs are designed to reimburse providers for care for patients who either lack or cannot use their insurance. 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. But states have long been on the forefront of protecting and expanding abortion access – including efforts to establish comprehensive insurance coverage. While there are tough fights coming, the policies highlighted in this blog are essential to creating an equitable abortion access landscape and those victories deserve to be celebrated. The National Health Law Program is dedicated to supporting state advocates working on abortion coverage and reimbursement issues – if you have any questions or need technical assistance, please contact Cat Duffy ([email protected]).
