Medicaid Rule Targeting Abortion Providers Set to Expire

A federal rule that bars Medicaid reimbursements to abortion providers is likely to lapse this summer, after congressional leaders from both chambers signaled they won’t include a renewal in the current spending bill.

The rule, part of the broad tax and spending measure President Donald Trump signed last summer, strips federal Medicaid funding from organizations that provide abortions and received more than $800,000 in Medicaid reimbursements in fiscal year 2023. It primarily targets Planned Parenthood, along with independent health care nonprofits such as Health Imperatives in Massachusetts and Maine Family Planning. The measure is set to expire July 4.

Congressional leaders say the current spending vehicle can’t carry it. Senate Majority Leader John Thune, a Republican from South Dakota, said the bill under consideration “has to be very narrow and tight.” Thune added that Republicans would look for “opportunities to address not only Planned Parenthood, but some of the other issues that might fit in a reconciliation bill,” according to a statement shared by a spokesperson. Republican House Speaker Mike Johnson of Louisiana is also not pursuing a renewal in the House version of the bill, the Washington Examiner recently reported.

Narrow focus. That’s the phrase leaders keep returning to, and it’s shutting out nearly every policy priority that doesn’t touch immigration enforcement directly. Congress has been working to address a two-month partial shutdown of the Department of Homeland Security, and leaders have framed the spending bill as a vehicle for immigration funding and little else.

Critics of the rule have argued from the start that its framing as an abortion funding ban was misleading. Federal law already bars Medicaid from paying for abortions except in cases of rape, incest, or life endangerment, a restriction that has been on the books for decades. What the Trump-era rule actually did was prevent clinics from receiving Medicaid reimbursements for birth control, infection testing and treatment, and a broad range of reproductive and primary care services that have no direct connection to abortion.

The consequences showed up quickly after the rule took effect. Kaitlyn Joshua, co-founder of Abortion in America and a Baton Rouge, Louisiana resident, said she feared patients would go without care after Planned Parenthood shut its only Louisiana health centers in response to the new rule. Louisiana is one of the states where Planned Parenthood’s closure created an immediate gap, since the organization served Medicaid patients who had few alternatives for basic reproductive health services.

Medicaid covers health insurance primarily for people with lower incomes and is funded jointly by the federal government and states, with Washington covering roughly two-thirds of the cost. When a provider like Planned Parenthood exits a state’s Medicaid network, low-income patients don’t simply find other options. They often go without.

Not every state has faced the same situation. Some, like South Carolina, had already excluded Planned Parenthood from their Medicaid programs before the federal rule took effect. South Carolina’s exclusion was upheld last year by the U.S. Supreme Court. Other states have moved in the opposite direction, using state Medicaid funds to cover abortion services directly.

For anti-abortion advocates, the rule’s likely expiration represents a significant setback. Johnson spoke at the March for Life rally in Washington, D.C., in January, presenting the Medicaid provision as a major Republican policy victory. With the rule now expected to lapse without renewal, the movement faces the prospect of losing that ground until Congress can find another legislative vehicle, most likely a reconciliation bill.

The New Hampshire Bulletin has tracked how the rule’s effects have rippled across states with active Medicaid programs and sizable Planned Parenthood networks. New Hampshire, which sits within a regional health care corridor that includes Dartmouth Health’s network in the Upper Valley, has its own population of Medicaid patients who rely on reproductive health providers for primary care. Any future federal rule with similar provisions would carry real consequences for patients across northern New England.