A new KFF analysis finds that 48% of women of reproductive age on Medicaid live in states that restrict coverage of abortion services.
Of the affected patients, 19% live in states that completely ban abortion, and 29% live in states that follow the Hyde Amendment. The regulation prohibits the use of federal funds for abortions, with exceptions for pregnancies resulting from rape or incest, or for pregnancies that endanger the pregnant woman’s life.
A March report from the Guttmacher Institute found that an estimated 1.126 million abortions will be provided in 2025, a number “virtually unchanged” from the estimated 1.124 million provided in 2024.
The cost of an abortion depends on several factors, including the facility and time of year. The median cost of a medical abortion is $563 and a second-trimester abortion $1,000, according to the report, but researchers note that 93 percent of abortions occur in the first trimester.
Analysis shows since Roe v. Wade reversal in 2022 Five additional states have eliminated Medicaid abortion coverage limits, and 21 states use their own funds to pay for abortions for people on Medicaid, independent of Hyde Amendment limits.
As of the end of 2025, 13 states have outright bans on abortion with limited exceptions, and six others have enacted six- or 12-week bans. KFF’s analysis said that while all states have exceptions to protect the life of a pregnant person, “most” states do not have exceptions in cases of rape or incest.
“Most Medicaid enrollees living in states that prohibit the provision of abortions will not be able to use their state’s insurance for a Hyde abortion, and those who are able to travel out of state are unlikely to be able to find a provider who can bill their home state’s Medicaid program,” the report said.
Additionally, 25 states continue to prohibit abortion coverage in Affordable Care Act (ACA) marketplace plans. In six states with no abortion coverage limits or requirements, no ACA plans provide coverage for abortion procedures. Researchers say this leaves people in 31 states unable to access qualified health insurance that covers abortions.
But 13 states now require ACA marketplace plans to cover abortion services, up from four states in 2019. Seven states have at least one plan that provides coverage in the absence of restrictions or requirements, down from 13 states in 2019.
“It is unclear why issuers in states that allow abortion coverage would choose to exclude abortion coverage, but the complexity of requirements specific to abortion coverage alone may be hindering plans,” the report states. “Plans that choose to include abortion coverage are also subject to additional reporting standards and auditing requirements, and must also charge a separate premium for the coverage.”
