State Insurance Coverage of Abortion Under Medicaid

January 22, 2026

This fact sheet was written by Krystal Leaphart. It was edited by Ian Lague.

Abortion is essential health care that should be accessible and affordable for all, but in reality, US abortion access has long been shaped by profound inequities. In 1976, just three years after the landmark Roe v. Wade decision, Congress passed the Hyde Amendment, which prohibits federal funds from covering abortion services for people enrolled in Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP), except in cases of life endangerment, rape or incest. The Hyde Amendment also impacts people who obtain their health care or coverage through the federal government in other ways, including federal employees and their dependents; military personnel and their dependents; veterans; Peace Corps volunteers; American Indians and Alaska Natives; and people held in federal prisons or detention centers.

The Hyde Amendment disproportionately impacts Black, Brown, and Indigenous communities and creates barriers to care, even in states where abortion is legal. In response to bans and limitations on insurance coverage for abortion, communities have long organized assistance like abortion funds and practical support networks to address financial barriers created by the Hyde Amendment and other restrictive policies.

Since Medicaid is a joint federal–state program, states can utilize their own Medicaid funds to provide this critical coverage. Currently, 20 states without total abortion bans allow state Medicaid funds to be used to cover abortion care beyond the limitations of the Hyde Amendment. By contrast, more than half of states plus the District of Columbia restrict Medicaid coverage in accordance with the Hyde Amendment, with some variation on additional exceptions, such as physical health or fetal condition. These and other limitations too often ensure that abortion access, regardless of its legal status, remains unequal, unaffordable and stigmatized.

Highlights

30 states and the District of Columbia restrict public insurance coverage for abortion care:

22 states and DC follow the federal standard imposed by the Hyde Amendment and ban public insurance coverage for abortions with exceptions allowed only in cases of life endangerment, rape or incest.
1 state limits exceptions to cases of life endangerment, in apparent violation of the federal standard.
7 states provide funds for other narrow exceptions to Hyde’s prohibitions:
- 4 of these states also provide Medicaid funds for abortions in case of fetal impairment.
- 4 of these states also provide Medicaid funds for abortions that are necessary to prevent grave, long-lasting damage to the pregnant person's physical health.

20 states use state funds to cover abortion care through Medicaid.

8 states cover all abortions for Medicaid enrollees.
12 states cover all or most abortions for Medicaid enrollees but require a designation of medical necessity.

Current Policy Status Table

State Insurance Coverage of Abortion Under Medicaid
Jurisdiction	Withholds coverage following Hyde, with exceptions for life endangerment, rape or incest	Withholds coverage following Hyde, with additional narrow exceptions	Uses state Medicaid funds to cover all or most abortions legal under state law
Alabama	X
Alaska			X*
Arizona		Physical Health
Arkansas	X
California			X
Colorado			X
Connecticut			X*
Delaware			X
DC	X
Florida	X
Georgia	X
Hawaii			X
Idaho	X
Illinois			X*
Indiana	X
Iowa		Fetal Condition
Kansas	X
Kentucky	X
Louisiana	X
Maine			X
Maryland			X*
Massachusetts			X*
Michigan	X
Minnesota			X*
Mississippi		Fetal Condition
Missouri	X
Montana			X*
Nebraska	X
Nevada			X*
New Hampshire	X
New Jersey			X*
New Mexico			X*
New York			X*
North Carolina	X
North Dakota	X
Ohio	X
Oklahoma	X
Oregon			X
Pennsylvania	X
Rhode Island			X
South Carolina	X
South Dakota	X (Life Endangerment only)
Tennessee	X
Texas	X
Utah		Physical Health
Vermont			X*
Virginia		Fetal Condition
Washington			X
West Virginia		Physical Health, Fetal Condition
Wisconsin		Physical Health
Wyoming	X
TOTAL	23+ DC	7	20

*These states cover all or most abortions for Medicaid enrollees but require a designation of medical necessity.

Suggested citation: Guttmacher Institute, State insurance coverage of abortion under Medicaid, State Laws and Policies (as of January 2026), 2026, https://www.guttmacher.org/state-policy/explore/state-insurance-coverage-abortion-under-medicaid.