On Third Anniversary of Dobbs Decision, Attorney General Bonta Co-leads Letter Reminding Hospitals of Their Obligation to Provide Emergency Abortion Care

OAKLAND – California Attorney General Rob Bonta today co-led a coalition of 22 attorneys general in sending a letter to the American Hospital Association reminding hospitals of their ongoing obligation to comply with the federal Emergency Medical Treatment and Labor Act (EMTALA). Every hospital in the United States that operates an emergency department and participates in Medicare is subject to EMTALA. Under the law, emergency departments are required to provide all patients who have an emergency medical condition with the treatment required to stabilize their condition, including abortion care. On May 29, 2025, the U.S. Centers for Medicare and Medicaid Services (CMS) rescinded guidance that it issued in 2022 “to remind hospitals of their existing obligation to comply with EMTALA”. CMS’s rescission of this guidance does not change federal law or the obligations EMTALA imposes. Put simply, all hospitals must continue to follow EMTALA, including with respect to the provision of emergency abortion care.

“When a medical emergency happens, patients must be assured that they can access life-saving care when they go to the hospital – that includes emergency abortion care,” said Attorney General Bonta. “Despite the Trump Administration’s attempt to sow confusion and fear among providers, EMTALA remains the law of the land and its obligations are clear: Hospitals must continue to provide emergency abortion care to prevent serious harm to patients’ health. Furthermore, states like California and many others have analogous state law protections, which we take very seriously. At the California Department of Justice, we remain steadfast in our commitment to ensuring that every hospital continues to follow the law, and we stand ready to work together with our sister states to ensure that every pregnant patient across the country receives the necessary and lifesaving healthcare that federal and state law require.”

Since 1986, EMTALA has mandated that hospitals provide critical and necessary healthcare in emergency medical situations. Under EMTALA, all Medicare-participating hospitals with an emergency department must provide pregnant patients access to abortion care to prevent serious harm to the patient’s health, serious impairment to bodily function, or serious dysfunction of an organ or body part. EMTALA requires these hospitals to provide access to abortion care if it is the treatment necessary to stabilize pregnant patients with an emergency medical condition. Emergency medical conditions can include, but are not limited to, ectopic pregnancy, traumatic placental abruption, pre-eclampsia, hemorrhaging, amniotic fluid embolism, and hypertension. Critically, the requirements of EMTALA apply regardless of whether a hospital is in a state that purports to limit or ban abortion care.

For decades, the federal government has properly interpreted the requirements of EMTALA to protect access to abortion care under the statute. Across federal administrations of both parties, the U.S. Department of Health and Human Services (HHS) has enforced EMTALA against hospitals who fail to provide abortion care when necessary to provide stabilizing care for a patient experiencing an emergency medical condition. Nothing about CMS’s rescission of its 2022 guidance changes the statutory text of EMTALA, which requires abortion care in specified circumstances. Nor does the rescission of the guidance supersede numerous judicial opinions interpreting EMTALA to require the provision of emergency abortion care. The Trump Administration itself has acknowledged as much in a letter sent to healthcare providers on June 13, shortly after the rescission of CMS’s 2022 guidance. In the letter, HHS Secretary Robert F. Kennedy, Jr., made clear that “the law has not changed.” And while that letter needlessly attempted to sow confusion by focusing on protections for a pregnant patient’s “unborn child,” nothing about the rescission of the guidance changes the fact that EMTALA’s requirement to provide stabilizing care is based on the medical condition of the pregnant patient, not the fetus. Hospitals in all states therefore must continue to comply with EMTALA and provide access to abortion care when it is the medical treatment necessary to stabilize a pregnant patient, regardless of state laws purporting to prohibit or limit access to abortion care.

Continued compliance with EMTALA’s requirements is critical in light of the severe harms that result from denying stabilizing abortion care to pregnant patients in emergency medical situations. Denying stabilizing abortion care can cause irreparable harms, including hysterectomy, fertility loss, kidney failure, brain injury, and limb amputation, forcing patients to live with significant disabilities and chronic medical conditions. Delaying such stabilizing care, meanwhile, increases the risk that lifesaving interventions might not work, risking the lives and health of pregnant patients. For example, a recent maternal morbidity study after the enactment of Texas’ six-week abortion ban found the rate of serious maternal morbidity was 57% when using observation-only care, nearly double the rate that resulted when following the standard protocol of terminating the pregnancy to preserve the pregnant patient’s life or health.

The real-world consequences of denying or delaying stabilizing abortion care for pregnant patients with an emergency medical condition are catastrophic. After Texas’s six-week abortion ban went into effect, sepsis rates rose 50% statewide and increased by 63% in hospitals that waited to provide abortions or other interventions to miscarrying patients. In Texas, a young mother experiencing a miscarriage died of an infection after being forced to delay abortion care for 40 hours until doctors, fearful of prosecution under Texas’s abortion ban, could no longer detect fetal cardiac activity. And HHS found as recently as May 2025 that a hospital violated EMTALA when a pregnant woman nearly died after being denied abortion care for her ectopic pregnancy, resulting in permanent damage to her reproductive organs. The devastating consequences of denying medically necessary abortion care to pregnant patients are a stark reminder of the importance of EMTALA’s requirements—and the importance of ensuring continued compliance with those requirements. The law is clear: Hospitals subject to EMTALA have an obligation to provide timely abortion care when necessary to stabilize a patient experiencing an emergency medical condition. 

In sending the letter, Attorney General Bonta is joined by the Attorneys General of New Jersey, New York, Arizona, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, North Carolina, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia. 

A copy of the letter is available here.