Map of State Policies Impacting the Provision of TMAB
Disclaimer: *This map intends to serve as guidance only and is not to be deemed as legal advice. State laws and regulations are evergreen and evolving and must always be analyzed and applied to a specific clinical application.
HIGHLIGHTS
CATEGORIES
All Virtual TMAB Provision Permitted: 26 states, 1 district, 1 territory (California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, Wyoming, Puerto Rico)
Only Hybrid TMAB Permitted: 5 states (Alaska, Georgia, Missouri, North Carolina, Utah)
TMAB Provision Banned: 19 states and 4 territories (Alabama, Arizona, Arkansas, Florida, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, West Virginia, Wisconsin, American Samoa, Guam, Northern Marianas, Virgin Islands)
SUBCATEGORIES
Explicit Ban on TMAB Provision: 18 states and 2 territories (Alabama, Arizona, Arkansas, Florida, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, West Virginia, American Samoa, Northern Marianas)
Implicit Ban on TMAB Provision: 1 state and 2 territories (Iowa, Guam, Virgin Islands)
Expanded Access: Shield Law for Out-of-State Care: 8 states (California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, Washington)
Expanded Access: Shield Law for In-State Care: 12 states and 1 district (Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Pennsylvania, Oregon)
Highlights
GLOSSARY
Telehealth: Telehealth enables health care clinicians to treat patients virtually without an in-person appointment. Patients can connect directly with a healthcare clinician from any location and this can be done in a variety of modalities ways, including via live synchronous video, synchronous audio-only, and asynchronous store-and-forward modalities, such as video (“synchronous”), the phone, secured chat (“asynchronous”), and other telecommunications. This can be delivered direct-to-patient, site-to-site, or via hybrid in-person/virtual care.
Medication Abortion (“MAB”): Medication abortion typically involves taking two different medications, Mifepristone and Misoprostol, to terminate a pregnancy up to 12 weeks. MAB care can be done through an in-person clinical visit, all virtual telehealth, hybrid-telehealth or people can choose to use MAB to self-manage their abortion.
Telehealth for Medication Abortion (“TMAB”): Generally refers to a patient’s use of a phone and/or video with a provider for some or all of the interactions to prescribe and receive medication abortion. TMAB can be direct-to-patient, site-to-site, or through a hybrid in-person/virtual care experience using different modalities.
All Virtual Telehealth Care: The provision of telehealth for medication abortion is provided entirely through virtual care. This can be site-to-site or direct-to-patient.
Hybrid Telehealth Care: The provision of telehealth for medication abortion care can be provided by telehealth in part, but not in entirety, because of state-mandated policies requiring a patient to have an in-person interaction.
Expanded TMAB Protections: The right to receive abortion care is protected by state statutes or state constitutions, and other laws and policies, including “shield laws,” that create additional access to abortion care.
Shield Law for In-State Provision of Care: Legal protections, including by executive order alone, that create state-specific protections for providers of abortion care, including abortion and telehealth for medication abortion providers, supporters, funds etc. treating and/or supporting a patient physically located in the shielding state.
Shield Law for Out-of-State Provision of Care: Legal protections, including by executive order alone, that create state-specific protections for providers of abortion care, including abortion and telehealth for medication abortion providers, supporters, funds etc. treating and/or supporting a patient physically located in the shielding state and patients physically located in a different state.
Ultrasound Requirement: A state-mandated requirement that an abortion seeker receive an ultrasound before abortion care, regardless of the healthcare provider’s medical recommendation. This requirement can be explicit or implicit.
RH Testing Requirement: A state-mandated requirement that an abortion-seeker undergoes blood testing and treatment for Rhesus (Rh) factor, a protein found in red blood cells, regardless of the healthcare provider’s medical recommendation.
In-Person Visitation Requirements: A state-mandated requirement that an abortion-seeker is physically present with their clinician during a certain stage of the abortion care process, regardless of the healthcare provider’s medical recommendation.
Medicaid: Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has guidelines that all state Medicaid programs must follow, but each state has flexibility in designing and administrating its programs. As a result, eligibility requirements and benefits vary widely from state to state.
Implicit TMAB Provision: State-mandated requirements, typically including numerous in-person visitation requirements, that practically inhibit the ability of a provider to utilize telehealth for any part of a patient’s abortion care process, regardless of the healthcare provider’s medical recommendation.
Explicit TMAB Provision: State-mandated Bans specifically restricting the provision of TMAB.
Site-to-Site: The provider and patient are located in different clinical sites using a secure video-conferencing platform for patient counseling, medication administration or dispensing, or supervising drug ingestion.
Direct-to-Patient: The provider and patient are located in different places while using either a secure video-conferencing platform, audio platform, or a secure messaging system (asynchronous care). This is a fully remote model and oftentimes, the patient is located outside of a clinical setting, such as in their home.
Glossary
Table
TABLE
Key
▶ = Explicit Ban on TMAB Provision
▷ = Implicit Ban on TMAB Provision
◐ = TMAB can only be provided via hybrid telehealth care
➏ = Abortion Provision Banned at 6-weeks
⑫ = Abortion Provision Banned at 12-weeks
⊕ = In-Person Visitation Requirements
◎ = Ultrasound Requirement
⏺ = All Virtual TMAB Provision Permitted
◾ = Expanded TMAB Protections: Shield Law for In-State Provision of Care
◻ = Expanded TMAB Protections: Shield Law for Out-of-State Provision of Care
✸ = A court injunction currently blocks the enforcement of a law that would otherwise prohibit TMAB provision
State or Territory |
TMAB Provision Banned |
Only Hybrid TMAB Permitted |
All Virtual TMAB Provision Permitted |
|---|---|---|---|
|
Alabama |
▶ |
|
|
|
Alaska |
|
⏺ ◐ ⊕ |
|
|
Arizona |
▶ |
|
|
|
Arkansas |
▶ |
|
|
|
California |
|
|
⏺ ◻ |
|
Colorado |
|
|
⏺ ◻ |
|
Connecticut |
|
|
⏺ ◾ |
|
Delaware |
|
|
⏺ ◾ |
|
District of Columbia |
|
|
⏺ ◾ |
|
Florida |
▶ ➏ |
|
|
|
Georgia |
|
◐ ◎ ➏ |
|
|
Hawaii |
|
|
⏺ ◾ |
|
Idaho |
▶ |
|
|
|
Illinois |
|
|
⏺ ◾ |
|
Indiana |
▶ |
|
|
|
Iowa |
▷ ➏ ⊕ ◎ |
|
|
|
Kansas |
|
|
⏺ ✸ |
|
Kentucky |
▶ |
|
|
|
Louisiana |
▶ |
|
|
|
Maine |
|
|
⏺ ◻ |
|
Maryland |
|
|
⏺ ◾ |
|
Massachusetts |
|
|
⏺ ◻ |
|
Michigan |
|
|
⏺ ◾ |
|
Minnesota |
|
|
⏺ ◾ |
|
Mississippi |
▶ |
|
|
|
Missouri |
|
◐ ⊕ ✸ |
|
|
Montana |
|
|
⏺ ✸ |
|
Nebraska |
▶ ⑫ |
|
|
|
Nevada |
|
|
⏺ ◾ |
|
New Hampshire |
|
|
⏺ |
|
New Jersey |
|
|
⏺ ◾ |
|
New Mexico |
|
|
⏺ ◾ |
|
New York |
|
|
⏺ ◻ |
|
North Carolina |
|
⑫ ◐ ⊕ |
|
|
North Dakota |
▶ |
|
|
|
Ohio |
|
|
⏺ ✸ |
|
Oklahoma |
▶ |
|
|
|
Oregon |
|
|
⏺ ◾ |
|
Pennsylvania |
|
|
⏺ ◾ |
|
Rhode Island |
|
|
⏺ ◻ |
|
South Carolina |
▶ ➏ |
|
|
|
South Dakota |
▶ |
|
|
|
Tennessee |
▶ |
|
|
|
Texas |
▶ |
|
|
|
Utah |
|
◐ ⊕ ✸ |
|
|
Vermont |
|
|
⏺ ◻ |
|
Virginia |
|
|
⏺ |
|
Washington |
|
|
⏺ ◻ |
|
West Virginia |
▶ |
|
|
|
Wisconsin |
▶ |
|
|
|
Wyoming |
|
|
⏺ ✸ |
|
American Samoa |
▶ |
|
|
|
Guam |
▷ |
|
|
|
Northern Marianas |
▶ |
|
|
|
Puerto Rico |
|
|
⏺ |
|
Virgin Islands |
▷ |
|
|