Editor’s Note: Manatt Health conducted a survey of all 34 states in which abortion is legal as of November 7, 2023, broadly classifying them based on their Medicaid coverage policies, private or exchange-based insurance coverage policies, and the extent to which they have budget or legislative initiatives intended to expand or otherwise promote access to reproductive health care, including abortion. The survey is intended to inform not only health care providers and state policymakers regarding the current state of abortion coverage (and opportunities to increase coverage) but also individuals and those who support them in obtaining abortions, who may be unaware of the coverage options afforded to them in a particular state.

Highlights of findings are captured below. 

Full results of our new abortion access and coverage survey—as well as of our recent state abortion shield law survey—will soon be available through Manatt on Health, Manatt’s legal and health policy subscription service covering the topics and trends that are transforming health care. Findings will be updated as new laws are enacted. Results of both surveys also can be accessed through stand-alone hard copy reports. 

As Manatt detailed in our September 2023 survey of state abortion shield laws, the legal landscape regarding abortion protections and restrictions continues to evolve rapidly in the wake of the Supreme Court’s decision in Dobbs to overturn Roe v. Wade. Some states have shored up protections for those seeking or providing abortions, with shield laws protecting individuals from out-of-state actions, through amendments to state constitutions enshrining abortion and other reproductive freedoms as a fundamental right, or by expanding access to abortion care.

Insurance coverage for abortion-related services is a crucial element of abortion access, and even across states where abortion is legal, there is significant variation in the extent to which such states allow Medicaid, private and exchange-based coverage of abortion. State budgets and other legislative initiatives for 2024 also provide a window into the direction that certain states are leaning when it comes to investment in or expansion of reproductive rights.

Manatt Health’s new survey classifies the 34 states in which abortion is legal as of November 7, 2023, according to their Medicaid coverage policies, private or exchange-based insurance coverage policies, and the extent to which they have budget or legislative initiatives intended to expand or otherwise promote access to reproductive health care, including abortion. 

We note that lawsuits are being filed and cases decided nearly every day that change the parameters of abortion access in states, whether in relation to its legality, at what point in a pregnancy abortion is no longer permitted or the extent to which abortion coverage is provided. The survey gives a high-level overview at a specific point in time of the access and coverage landscape and will be updated periodically.  

Key Findings

As of November 7, 2023, the Medicaid programs of 16 states appear to cover abortions in circumstances beyond rape, incest or danger to the life of the mother using state-only dollars; 11 states appear to require private and/or exchange-based plans to cover abortions.

State insurance laws tend to have some combination of the following coverage policies:

• Those that permit Medicaid coverage abortion only in the narrow circumstances of rape, incest or danger to the life of the mother (e.g., Arizona and Kansas)
• Those that permit or require the use of state Medicaid funds to cover abortion (e.g., California and Illinois)
• Those that require any insurance plan offered in the state to cover abortion (e.g., Maine and Massachusetts)
• Those that prohibit any insurance plan offered in the state from covering abortion, except under narrow circumstances (e.g., Kansas and Nebraska)

A number of states neither require nor prohibit private insurance coverage of abortion, but have requirements or prohibitions specific only to plans offered through an exchange (e.g., Florida and Ohio).

State budget initiatives related to abortion care tend to be focused on investment in family planning services, facility upgrades and assistance to providers in order to expand their care capacity. Several states had such initiatives.