Commonwealth Court Strikes Down Exclusion on Medicaid-Funded Abortions

On Monday, the Commonwealth Court struck down the provision of Pennsylvania’s Abortion Control Act that prohibited the use of Medical Assistance (Medicaid) funds to pay for an abortion, except in limited circumstances. The court found the provision violated the Pennsylvania Constitution and enjoined the Commonwealth from enforcing the restriction moving forward.

The case, Allegheny Reproductive Health Center v. Pa. Department of Human Services, was brought by several abortion providers (Providers) against the Department of Human Services (DHS), challenging Sections 3215(c) and (j) of the Abortion Control Act. Those provisions (the Coverage Exclusion) prohibited the use of Medicaid funds to pay for the performance of an abortion unless the abortion was necessary to save the life of the mother, or the pregnancy was the result of rape or incest.

Initially, the Commonwealth Court dismissed the case back in 2021, determining that the Providers lacked standing to sue and that the issue had been previously decided by the court. Following review on appeal, the Pennsylvania Supreme Court remanded the case back to the Commonwealth Court after finding that the Providers did have standing to sue  and that the prior decision on the Coverage Exclusion was not beyond being overruled.

When reviewing the case, the Supreme Court also concluded that the Coverage Exclusion violated both the Equal Rights Amendment and the Equal Protection provisions of the Pennsylvania Constitution. The Supreme Court concluded that the Coverage Exclusion was a sex-based classification that violated the state constitution’s Equal Rights Amendment (Pa. Const. Art. I, § 28). A plurality of the Supreme Court also found that abortion was a fundamental right. Therefore, the Coverage Exclusion burdened a fundamental right in violation of the state constitution’s equal protection provisions (Pa. Const. Art. I, § 1, 26; Art. III, § 32).

As the provisions were presumed unconstitutional, the Commonwealth Court on remand needed to subject the Coverage Exclusion to strict scrutiny, the court’s most rigorous statutory analysis. Under strict scrutiny, the Coverage Exclusion was presumed to be unconstitutional, and DHS then possessed the burden to rebut the presumption with evidence of a compelling state interest in the policy and that no less intrusive means was available to carry out the policy.

After the case returned to the Commonwealth Court, DHS announced that it would no longer defend the constitutionality of the Coverage Exclusion. This left no party in opposition to the Providers, so the Providers sought a summary decision by the Commonwealth Court without a hearing. The Pennsylvania Attorney General (Attorney General) then applied to join the case and was granted permission to enter case. The Attorney General filed a brief and participated in oral argument supporting the Coverage Exclusion.  

Ultimately, in a 4-3 decision, the Commonwealth Court determined that the Coverage Exclusion did not survive strict scrutiny. Therefore, the unconstitutionality of the Coverage Exclusion was confirmed. Significantly, the Commonwealth Court also stated that Article I of the Pennsylvania Constitution guarantees a fundamental right to reproductive autonomy.

This decision is subject to review by the Pennsylvania Supreme Court if review is sought by the Attorney General. The Attorney General has 30 days from April 20, 2026 to seek such review.

You can read the court opinion and concurring and dissenting opinions here.