The conflict over whether Medicaid could pay for an abortion has been raging since the 1970s. However, in recent years, courts have more frequently confronted state constitutional questions about abortion funded by Medicaid. The lawsuits on this question have increased as more state courts discovered as the constitution protects abortion and citizens often pass amendments to abortion rights.
From Hyde’s amendments to Trump’s budget bill
Medicaid is jointly funded by the state and federal governments. Hyde’s amendment passed by Congress in 1976 prohibiting individuals from using federal Medicaid dollars to refund abortions. There were various policies regarding the state dollar. In addition to states where abortion is a crime, another 17 states followed Hyde’s amendments in their own policies. However, anti-abortion groups are pushing to further limit the availability of Medicaid for abortion, earning their recent victory.
One focus is a strategy to reimburse planned parents and other abortion providers by blocking participation in Medicaid, despite these providers being refunded solely for non-abortion services. As part of “One Big Beautiful Bill Act,” Congress imposed a one-year ban on Medicaid participation in healthcare providers that primarily provide reproductive care and provide abortion. Following last month’s decision by the US Supreme Court Medinav. Planned Parenthood of South Atlanticstates thought they could exclude planned parents from Medicaid programs without violating federal clauses that provide provider choice for Medicaid patients, so some states could oust planned parent-child relationships from state Medicaid programs.
At the same time, voters passed amendments to protect abortions. The US Supreme Court said there is no federal right to abortion in 2022. Dobbs v. Jackson Women’s Health Agencyvoters in 10 states approved abortion rights initiatives, including conservative states. And many state courts say their constitution offers at least some abortion protections, even without an explicit amendment.
But even states protecting abortions have been featured in books. All over the country, litigators argue that these prohibitions violate the state’s constitutional rights to abortion, privacy and equal rights.
Michigan abortion advocate set
A Michigan judge recently rejected the challenge to the state’s Medicaid abortion restrictions. The lawsuit was filed by the ACLU on behalf of the YMCA in Kalamazoo. It maintains a fund that provides financial support to those seeking abortion. The YMCA argued that Michigan law violated the right to reproductive freedom, disliked abortion, a procedure that was discriminated against on the basis of gender and protected in favor of childbirth.
However, the judges did not reach the constitutionality of the ban. Instead, he decided he was not standing in the YMCA. He rejected the YMCA’s claim that the interests were directly harmed by the statute. Because 77% of the fund wanted Medicaid-eligible abortions, the YMCA argued that it could not support other suitable patients at a cost. The judge said the state amendment was Individual The right to freedom of reproductiveness. The organization may be trying to sue on behalf of individual members, but the YMCA did not have such members. And while this amendment protected businesses and individuals being punished for providing certain types of care, the YMCA was not an abortion provider.
The court also addressed whether the YMCA could rely on the so-called taxpayer status. The court stressed that it could not find an example of a taxpayer standing to enforce the government. spend money. Such readings were incredible, the court reasoned that it opened the door to many challenges to budget decisions.
Privacy-based victory
Michigan courts are not the first to hear of a lawsuit challenging a ban on the use of Medicaid to fund abortions. In March, a Montana district judge issued an injunctive rule prohibiting Medicaid reimbursement for abortion patients unless they are either rape or incest survivors or suffer from a “at risk of death” health. The order also blocked rules that require that only physicians (with other providers) can perform Medicaid abortions, narrowly define the medical necessity of abortion procedures, and required prior permission for such procedures. The judge said the rules violated the state’s equal protection clause – the state has selected abortions to limits that do not apply to other reproductive health services and to protect the privacy of the state’s constitution.
The Montana Supreme Court has long held that the privacy rights in the state constitution protect abortion. The state argued that the privacy rights did not apply to the case as it included state discretion regarding how funds were allocated. The lower court disagreed: Because the state chose to provide funds Some Medicaid services could not deny the benefits of constitutional procedures just because lawmakers disliked them.
The rules already violated the right to abortion, and the courts applied the most demanding form of judicial review, strict scrutiny. The court said that doctor-only restrictions mean little when other providers provided high quality care as well. Similarly, the court said the state had no prior approval to eliminate telehealthcare or evidence that in-person visits would improve patient safety. The court also rejected a strict definition of medical necessity, with no health-based reasons. The state’s flat ban on reimbursement for any incident that does not involve rape, incest, or threats to life, presented an even simpler case.
Equal rights theory
Other cases are developed based on the equal rights argument. In Nevada, an organization that helps to cover abortion costs for low-income patients has sought a mandama warrant to establish that state equal rights amendments to prohibit discrimination based on gender would require a refund of abortion services. Mandamas warrants are an extraordinary remedy and are only available in the absence of an alternative to grant parties a prompt and effective solution. Nevertheless, the court agreed that the warrant would allow state officials to exempt from necessary obligations based on the times and that the state’s actions to refuse refunds were “arbitrarily or whimsical.”
A Nevada court rejected the state’s claim that discrimination based on pregnancy or abortion is not sex discrimination. “Laws like compensation exclusions targeting gender-specific traits for worse treatment are as unfavourable as laws that explicitly target “women,” the court said. Even if there is a clause do not have The court concluded that discrimination based on gender would fail to rational basis. The state could not justify the Medicaid ban on cost reductions, as it is actually more expensive than the alternative.
The court also rejected the state’s argument that the plaintiffs had no position. We reasoned that eliminating compensation exclusions would make a big difference for the organization, as exclusions put a strain on resources and limited their ability to assist clients. The lower court’s decision is standing as the state did not appeal.
The Pennsylvania Supreme Court similarly determined last year that state laws that allow Medicaid refunds only in cases of rape, incest, or threats to life are presumably unconstitutional under that state’s equal rights amendment. The plaintiffs argued that Medicaid exclusion was counted as sexism because comparable provisions were not applied to men and because the state chose abortion for exclusion while covering more expensive reproductive services. The justice of the majority of three seemed to find the reasoning to be persuasive, but two of the three reasoned that they had a fundamental right to abortion under the state constitution, and that state Medicaid exclusion discriminated against women who exercised that right. The majority of third justices found that this question was not necessary given the court’s decision on equality arguments. The court remanded the case for further action.
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The Medicaid funding lawsuit for abortion is a reminder of how state courts define reproductive rights in a completely different way and in a much broader way than previous federal courts. dobbs It was overturned Roev. Wade’s Abortion Protection, when several state courts find that prohibiting Medicaid refunds for abortion violated the state’s equality clause. today, egg With states no longer amending constitutions to protect reproductive rights, there is a new urgency surrounding questions about whether and how state constitutions protect Medicaid patients seeking abortion.
Mary Ziegler is Martin Luther King Jr. Professor of Law at the University of California, Davis School of Law. Her new book, Personality: A new civil war over reproductionnow available.
Suggested Quote: Mary Ziegler, The fight for Medicaid funding for abortionsᴛᴛᴇcᴏᴜʀᴛrᴇᴘᴏʀᴛ (July 28, 2025), https://statcourtreport.org/our-work/analysis-opinion/battles-ver-medicaid-punding-abortion
