A Pennsylvania appeals court on Monday struck down a law prohibiting state Medicaid dollars from covering elective abortions, intensifying the conflict over abortion access in the commonwealth.
In a 4-3 ruling, the Commonwealth Court of Pennsylvania, one of the state’s appeals courts, recognized a fundamental right to “reproductive autonomy” in a long-awaited case on whether the state-funded health insurance program for low-income residents could cover abortions outside of emergency circumstances.
Judge Matthew Wolf wrote for the majority, cementing that recognizing a fundamental right to abortion is necessary to prevent government “attempts to coerce reproductive choice.”
“Those choices are the People’s, not the government’s,” Wolf wrote.
Three of the four judges, including Wolf, who voted to strike down the law, were elected to the court as Democrats.
The ruling marks the latest development in a lawsuit filed by seven abortion providers in 2019, arguing that the state’s prohibition on the use of state Medicaid funds for abortion violated the Equal Rights Amendment in the commonwealth’s constitution.
Medicaid is a state-operated health insurance program for low-income residents jointly funded by the federal and state governments. Federal Medicaid dollars are prohibited from covering abortions other than those in circumstances of rape, incest, or to save the life of the mother.
The case, argued by the Women’s Law Project, reached the Pennsylvania Supreme Court in 2024, which ordered the commonwealth court to reexamine the case to determine whether the restriction was constitutional under the highest level of scrutiny.
Pennsylvania, which has roughly 3 million out of the nation’s 70 million Medicaid recipients, is one of 30 states that prohibits state Medicaid dollars from funding elective abortions.
The commonwealth allows abortion up to 24 weeks of pregnancy. Pennsylvania’s health department recorded nearly 33,000 abortions in 2024.
Gov. Josh Shapiro (D-PA) lauded the announcement on X, saying that he has “long opposed this unconstitutional ban.”
“As Governor, I did not defend it — because a woman’s ability to access reproductive care should never be determined by her income,” Shapiro said on social media.
But Shapiro did not overtly support abortion providers in the case, either. The governor’s office did not submit a brief supporting the plaintiffs in the case, and it is unclear whether it will do so should the case go to the Supreme Court.
Shapiro is running for reelection this November against Republican challenger and State Treasurer Stacy Garrity. He is also considered a possible Democratic presidential candidate in 2028.
