Forty-eight percent of reproductive-age women enrolled in Medicaid live in states restricting coverage of abortion services, a new analysis from KFF found.
Among affected patients, 19% live in a state that bans the provision of abortion entirely and 29% live in a state that follows Hyde Amendment restrictions—which bans the use of federal funds for abortions, with exceptions to pregnancies that result from rape or incest, or those that endanger the life of the pregnant person.
An estimated 1.126 million abortions were provided in 2025, according to a March report from the Guttmacher Institute, which notes the figure is “largely unchanged” from the estimated 1.124 million provided in 2024.
Abortion costs vary due to several factors, including facility and timing. The median cost of a medication abortion is $563 and a second-trimester abortion is $1,000, the report said, though researchers note 93% of abortions are performed during the first trimester of pregnancy.
The analysis said that since the 2022 overturning of Roe v. Wade, five more states eliminated Medicaid abortion coverage restrictions and 21 states use state-only funds to pay for abortions for those on Medicaid in circumstances aside from Hyde Amendment limitations.
Thirteen states have total abortion bans with limited exceptions as of the end of 2025, while six others have six- or twelve-week bans enacted. The KFF analysis said that while all states have exceptions to protect the life of the pregnant person, “most” do not have exceptions for cases of rape or incest.
“Most Medicaid enrollees living in states where abortion provision is prohibited are not able to use their coverage in their state for an abortion that qualifies as a Hyde circumstance and those who can travel out of state will most likely not be able to find a provider able to bill their home state’s Medicaid program,” the report said.
Moreover, 25 states continue to ban abortion coverage in Affordable Care Act (ACA) Marketplace plans. In six states that do not have abortion coverage restrictions or requirements, no ACA plans offer coverage for the procedure. This leaves individuals in 31 states without access to a qualified health plan that covers abortions, researchers note.
Thirteen states, however, now require ACA marketplace plans to cover abortion services—up from four states in 2019. Seven states have at least one plan offering coverage where no restrictions or requirements exist, though the figure is down from 13 states in 2019.
“While the reasons why issuers in states that permit abortion coverage choose to exclude abortion coverage are not known, it is possible that the complexity of the requirements specific only to abortion coverage could be a deterrent to the plans,” the report said. “Plans that choose to include abortion coverage are also subject to additional reporting standards and audit requirements, and must also charge a separate premium for the coverage.”