(Updated September 28, 2023) 

State and federal efforts to limit abortion coverage began soon after the 1973 Supreme Court’s Roe v Wade decision. In 1977, the Hyde Amendment banned federal funding for abortion, with exceptions for pregnancies that endanger the life of the woman, or result from rape or incest. Some states use their own funds to cover other medically necessary abortions under Medicaid or have been compelled to do so by the courts. The passage of the ACA in 2010 led to renewed legislative efforts to limit abortion coverage, this time in private insurance plans. The ACA maintains the Hyde Amendment’s limits, and permits states to ban abortion coverage from Marketplace plans. Since 2010, many states have enacted private plan restrictions and also banned abortion coverage from Marketplace plans, some of which are more restrictive than the Hyde limitations. A handful of states, however, have enacted laws that require Medicaid and private plans to cover abortion. This interactive map shows the increase in states with laws restricting abortion coverage in Medicaid and private insurance 2010 to the present.

On June 24, 2022, the Supreme Court overturned Roe v. Wade, eliminating the federal constitutional standard that had protected the right to abortion. States can now set their own policies to ban or protect abortion. As of September 28, 2023, 14 states have banned abortion (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia). For more details about legal status of abortion in states, please visit our Abortion in the United States Dashboard.

Medicaid Coverage Limitations (33 states & DC) – State limits Medicaid coverage of abortion to the Hyde Amendment restrictions (only allowed in the cases of rape, incest or life endangerment).

Private Insurance Coverage Limitations (11 states) – State has a law that prohibits coverage of abortions from being included in private insurance policies sold in the state (with certain exceptions). Private insurance includes individual, small group, and large group. Some states may allow abortion coverage to be purchased as a rider.

State Marketplace Coverage Limitations (26 states) – State has a law that prohibits plans sold on state Marketplaces from covering abortion (with certain exceptions).

No Coverage Limitations (7 states) – State does not limit coverage of abortion in private insurance or the state Marketplace and the state Medicaid program permits the use of state funds (non-federal) to pay for abortion in circumstances outside of those allowed by the Hyde Amendment.

Requires Abortion Coverage in Medicaid, Private and ACA Marketplace Plans (9 states) – State has a law that requires all fully-insured group plans and individual plans to include abortion coverage with no cost-sharing.

How State Policies Shape Access to Abortion Coverage – Abortion Interactive 2010

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