Allegheny Reproductive Health Center v. Pennsylvania Department of Human Services
No. 26 M.D. 2019 (Pa. Cmwlth., filed April 20, 2026)
A four-judge majority of the Pennsylvania Commonwealth Court ruled April 20 that Section 3215(c) and (j) of Pennsylvania’s Abortion Control Act violates the Pennsylvania Constitution. The law bars Medicaid from covering most abortions. The court permanently enjoined the Commonwealth from enforcing the ban.
Medicaid is a joint federal-state program. The federal Hyde Amendment, renewed by Congress annually since 1976, already prohibits federal Medicaid dollars from paying for abortions except in cases of rape, incest, or life endangerment. Pennsylvania’s Coverage Exclusion tracks Hyde almost exactly. What this ruling requires is that Pennsylvania cover abortions using state Medicaid funds, joining roughly a dozen states that already do so voluntarily or under court order.
The case began in 2019 when abortion providers sued, arguing that the state funds all pregnancy-related care except abortion, and that the gap constitutes unlawful sex discrimination. Commonwealth Court initially dismissed the case. The Pennsylvania Supreme Court reversed in 2024, overruled its own 1985 precedent in Fischer v. Department of Public Welfare, and sent the case back with instructions to apply a tougher constitutional framework. On remand, the Department of Human Services dropped its defense of the law. The state Attorney General intervened to defend it.
What the Court Held
Equal Rights Amendment. Pennsylvania’s ERA says rights may not be denied “because of the sex of the individual.” Under the 2024 Supreme Court remand, any sex-based classification is presumptively unconstitutional, and the government bears the burden of showing a compelling interest served by the least intrusive means available. Judge Matthew Wolf, writing for the majority, concluded the Attorney General’s three arguments did not clear that bar. The asserted interests were preserving fetal life, protecting women from psychological harm, and respecting taxpayer conscience. None, the court held, qualifies as compelling in this context. Even if they did, the Coverage Exclusion is not the least restrictive way to pursue them. Investment in maternal healthcare, infant support programs, and WIC would serve any pro-life interest without forcing women to carry pregnancies against their will.
Equal Protection. The court held for the first time that reproductive autonomy is a fundamental right under Article I of the Pennsylvania Constitution. Because the Coverage Exclusion funds childbirth while withholding coverage for abortion, it does not operate neutrally with respect to that right. That triggers strict scrutiny, which the law also fails.
Rational Basis as a Backstop. Even without a fundamental right in the analysis, the majority said, the law fails rational basis review. The Coverage Exclusion contains no exception for pregnancies where the fetus cannot survive. A law that refuses to fund an abortion even when there is no viable life to preserve cannot be rationally related to an interest in preserving life. The statute, the majority concluded, must be pursuing some other purpose, or no coherent purpose at all.
The Dissents
Three judges dissented across two opinions. Judge Patricia McCullough, joined by Judges Covey and Wallace, argued the majority granted relief without a hearing, without factfinding, and without ever requiring the government to present evidence. The Attorney General had specifically requested a trial. McCullough also challenged the constitutional foundation for a “fundamental right to reproductive autonomy,” arguing that right has no textual basis in the Pennsylvania Constitution and that creating it is a job for voters amending their constitution, not for judges.
Judge Stacy Wallace, joined by McCullough, called the equal protection holding a “power grab” that strips the legislature and the electorate of authority over abortion policy. Wallace argued the majority violated basic judicial restraint by reaching the equal protection question at all, since the ERA holding was independently sufficient to decide the case.
What It Means
If the decision stands, Pennsylvania Medicaid must cover abortions for eligible patients on the same terms as all other pregnancy-related care, with the cost falling on state appropriations rather than federal funds. The case now goes to the Pennsylvania Supreme Court, which will decide whether Commonwealth Court correctly applied the framework it established in 2024.
Arguments on Appeal
The Attorney General will appeal to the Pennsylvania Supreme Court. Several arguments have real potential.
1. The Right to a Hearing
This is the dissents’ strongest point. The 2024 Supreme Court mandate told Commonwealth Court to apply a new standard requiring the government to prove compelling interest and least-restrictive means “with evidence.” The majority acknowledged that language but concluded the Attorney General’s proffered facts were immaterial even if proven. On appeal, the Attorney General can argue the majority resolved contested factual questions as a matter of law without allowing a record to be built. Three issues the Attorney General wanted to prove at trial were the psychological impacts of abortion, the biological facts of fetal development, and future budgetary consequences of the ruling. Whether those issues would change the outcome is a separate question. The question on appeal is whether the majority was entitled to dismiss them without a hearing. The dissents argue, with some force, that it was not.
2. Funding Is Not Coercion
The majority framed the fetal-life interest so narrowly that it became self-defeating: by the court’s logic, the only way to articulate a pro-life funding interest is to admit the state wants to force women to give birth. The Attorney General can argue that the distinction between what the government funds and what it compels is not a technicality. Federal doctrine under Maher v. Roe and Harris v. McRae has long held that declining to subsidize a choice is not the same as burdening the right to make it. The Pennsylvania Supreme Court departed from federal lockstep on these provisions, but it did not explicitly repudiate every principle those cases established. This argument is worth pressing.
3. The Fundamental Right Holding Is Unsettled
The Pennsylvania Supreme Court’s 2024 decision recognized reproductive autonomy as a fundamental right only in a plurality opinion, not by a majority. Commonwealth Court adopted that plurality reasoning as binding. On appeal, the Attorney General can argue the lower court exceeded its remand authority by resolving a question the Supreme Court itself had not resolved by majority vote. This gives the high court an opening to revisit the question on a fuller record, with adversarial briefing that was not available the first time.
4. Rational Basis and the Missing Exception
The majority’s rational basis analysis is its most vulnerable section. The court concluded the Coverage Exclusion fails rational basis because it lacks an exception for fatal fetal anomalies, reasoning that a law indifferent to non-viable pregnancies must be pursuing something other than preserving life. That inference is contestable. Legislatures routinely draw categorical lines without carving out every edge case, and rational basis review does not require precise tailoring. The majority’s analysis here looks more like the strict scrutiny it had already applied. Saying so on appeal is a legitimate and concrete objection.
5. The Unpleaded Establishment Clause Reference
The majority’s treatment of the conscience interest included a brief reference to the Establishment Clause, a provision no party raised in the litigation. McCullough’s dissent identified this as error. Invoking an unpleaded constitutional provision to undermine a statutory interest is a procedural irregularity that can be raised on appeal independent of the substantive merits, and it signals the kind of free-ranging reasoning that sometimes leads appellate courts to remand for a more disciplined analysis.
The Bottom Line
The evidentiary process argument gives the Attorney General the best path to remand, if not full reversal. The Pennsylvania Supreme Court took an expansive view of these constitutional questions in 2024 and is unlikely to abandon the ERA holding. But a court that spent years criticizing the delay in this case may still be receptive to the argument that a permanent injunction on a question of this magnitude should not have issued without a trial.
Disclaimer: This does not constitute legal advice.