Pennsylvania Court Strikes Down Decades-Old Medicaid Abortion Funding Ban

A Pennsylvania appellate court on Monday struck down a decades-old law barring state Medicaid funds from covering abortions, ruling that the state constitution guarantees a fundamental right to reproductive autonomy.

The decision by a divided seven-judge panel of the Commonwealth Court permanently enjoins enforcement of Section 3215(c) and (j) of Pennsylvania’s Abortion Control Act, a funding restriction in place since 1982.

The case was originally filed in 2019 by Allegheny Reproductive Health Center, several abortion clinics, and Planned Parenthood affiliates.

A Case Seven Years In The Making

The court ruled that the Coverage Exclusion, which barred Medicaid payments for abortions except in cases of rape, incest, or threat to the mother’s life, violates both Pennsylvania’s Equal Rights Amendment and its equal protection provisions.

Writing for the majority, Judge Matthew Wolf concluded the state failed to demonstrate a compelling interest that could justify the sex-based classification. The court found that no comparable Medicaid coverage ban exists for men’s reproductive healthcare.

The ruling follows a 2024 Pennsylvania Supreme Court decision that overruled a 1985 precedent and sent the case back to the Commonwealth Court for further review.

A Divided Court

Three judges dissented. Judge Patricia McCullough argued the majority granted summary relief without a hearing or factfinding, denying the Commonwealth the opportunity to present evidence. Judge Stacy Wallace warned that the ruling strips the legislature of its policy-making authority.

The Attorney General’s office, which intervened to defend the law, asserted three compelling state interests protecting fetal life, preserving maternal health, and respecting taxpayer conscience rights. The majority rejected all three. The ruling can still be appealed to Pennsylvania’s Supreme Court.

Broader Medicaid Pressures Mount

The ruling arrives as Medicaid faces mounting federal pressure. Proposed cuts exceeding $900 billion under the Trump administration’s One Big Beautiful Bill Act have put nearly 450 hospitals at high closure risk, according to watchdog group Public Citizen.

Bank of America Securities estimates hospitals will face a 2–4% EBITDA headwind annually for five years, with Universal Health Services Inc. (NYSE:UHS) and Ardent Health Inc. (NYSE:ARDT) among those most exposed.

Abortion remains legal in Pennsylvania through 23 weeks of pregnancy

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