Maryland’s Approach to Enhancing Access to Abortion: Expanding Scope of Practice
January 26, 2023
Overview
Maryland’s Abortion Care Access Act is the first of its kind in the U.S. The new law expands the scope of practice for certain health care providers to allow them to provide abortion care, aims to increase provider diversity through training programs, and improves affordability and equity by requiring insurance coverage for abortion care. Experience and evaluation will help determine whether it is effective at improving safe, convenient, and equitable access to abortion care in Maryland. If so, it could serve as a model for other states looking to increase access, improve patient outcomes, and reduce health inequities.
Equitable access to safe and convenient abortion care has been a pressing public health concern for decades, even under Roe v. Wade. The Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization overturning Roe and eliminating the constitutional right to abortion has created even more avenues for states to severely restrict access to abortion care, exacerbating the public health problems associated with reproductive health care access and maternal morbidity and mortality. Nevertheless, states that want to ensure all pregnant people have access to safe abortion care have myriad options. Expanding the types of health care professionals who may provide abortion care is one of the options that Maryland adopted in 2022. The new law expands the scope of practice for certain health care providers to allow them to provide abortion care, aims to increase provider diversity through training programs, and improves affordability and equity by requiring insurance coverage for abortion care.
The Supreme Court’s decisions in Roe and Planned Parenthood v. Caseyplaced protections on abortion access under the U.S. Constitution. Because states could not fully ban abortion following these decisions, some attempted to restrict access by limiting who could provide abortions and where such care could take place. Thirty-two states permit only physicians to perform abortions and 19 permit certain abortions to be performed only in a hospital. After the Supreme Court overturned Roe, states began limiting abortion access even further, some implementing near total bans on the procedure. In just the first 100 days following Dobbs, 66 clinics across 15 states were shut down, leaving pregnant people in 14 of those states without access to a single clinic.
In contrast to the restrictive actions some states have taken following Dobbs, the Maryland legislature in 2022 enacted a law designed to expand access to abortion in the State by expanding the type of medical professionals permitted to provide abortion care. The Abortion Care Access Act, enacted after a veto override, expands the group of healthcare providers authorized by law to administer abortion care from physicians to all “qualified providers.” Qualified providers include physicians, nurse practitioners, midwives, physician assistants, and any other medical professionals properly licensed in the State and who are qualified to provide abortion care according to their licenses and/or certifications. The Act does not change licensing requirements or other qualifications for medical professionals, only their legal ability to perform abortion procedures they are already qualified to perform. The Act also does not change who may receive an abortion or when an abortion may be administered, but expanding medical professionals’ permissible scope of practice to meet their education, training, and skills increases access to care and can diminish health inequities.
In addition to expanding the scope of practice for medical professionals qualified to perform abortions, the Abortion Care Access Act also creates the Abortion Care Clinical Training Program, which will “protect access to abortion care by ensuring that there are a sufficient number of health professionals to provide abortion care.” The program will fund and administer grants for abortion care training programs for qualified providers in at least two community-based provider sites. One of the stated goals of the Training Program is to “increase the racial and ethnic diversity among health care professionals with abortion care training.” This diversity will improve patient outcomes. The Act calls for an annual allocation to the Program of $3.5 million starting on July 1, 2023. While Maryland’s former Governor had the authority to release funds early in order to start the Training Program before July 2022, he refused to do so. On his first full day in office on January 19, 2023, Maryland’s new Governor, Wes Moore, released the $3.5 million for the Program, allowing training to commence.
The Act also requires most insurers that cover labor and delivery services, including the State’s Medicaid program, to cover abortion services without imposing restrictions contrary to state abortion law and without charging deductibles, coinsurance, copayment, or any other cost-sharing requirement.
The Abortion Care Access Act is the first of its kind in the U.S.; experience and evaluation will inform if it is effective at improving safe, convenient, and equitable access to abortion care in Maryland. That evaluation could support Maryland law serving as a model for other states looking to increase access, improve patient outcomes, and reduce health inequities. Supporters of the Act have already expressed interest in expanding the Training Program to neighboring states and implementing further protections for individuals traveling from out of state to receive abortion care.
This post was written by Brianne Schell, J.D., M.A., Staff Attorney, Network for Public Health Law – Eastern Region Office.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.