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State Laws

Maryland


Political Information

Executive (Governor)

Mixed-choice

Senate

Pro-choice

House

Pro-choice

Abortion-Care Policies

Abortion Providers

Abortion Providers: Restrictions

Abortion-Specific Health and Safety Standards

Maryland has a reasonable set of health and safety standards that it applies singularly to abortion providers.  

Any facility that provides surgical abortion as a "regular" service must be licensed as a surgical abortion facility and follow a routine set of health and safety standards.   Md. Regs. Code tit. 10, §§ 10.12.01, -02.  Md. Regs. Code tit. 10, §§ 10.12.04, .05 (B)(2), .10, .17-20.

Restrictions on Who May Provide Abortion Services

Maryland prohibits certain qualified health-care professionals from providing abortion services.

Only a physician licensed by the state to practice medicine in the state may provide abortion services.  Md. Code Ann., Health-Gen. § 20-207 (Enacted 1970; Last Amended 1982), Md. Code Ann., Health-Gen. §20-208 (Enacted 1991).


Abortion Rights

Protections: Freedom of Choice Act (FOCA)

Maryland has created additional protections for reproductive rights by adding an affirmative right to choose into its state law.  In 1991, the legislature passed a pro-choice law asserting that the state could not interfere with a woman’s right to decide whether or not to continue her pregnancy within the boundaries established in Roe v. Wade.  

Anti-choice groups collected petitions to force the measures contained in the new law onto the 1992 ballot with the intent to repeal the law, but Maryland voters overwhelmingly approved the law.  This law ensures women’s access to pre-viability abortion services and would remain in effect even if Roe v. Wade were overturned.  Sandy Banisky, Voters Reaffirm Stand Favoring Abortion Choice, Balt. Sun, Nov. 5, 1992.

"[T]he State may not interfere with the decision of a woman to terminate a pregnancy:  (1) Before the fetus is viable; or (2) At any time during the woman’s pregnancy, if [t]he termination procedure is necessary to protect the life or health of the woman; or . . . [t]he fetus is affected by genetic defect or serious deformity or abnormality."  Md. Code Ann., Health-Gen. § 20-209 (Enacted 1991).


Post-Viability Ban

Maryland’s post-viability abortion restriction provides that abortion may be prohibited after viability unless necessary to preserve the woman’s life or health or unless the fetus is affected by a genetic defect or serious deformity or abnormality. Md. Code Ann. Health-Gen.  §20-209 (Enacted 1991).

NARAL Pro-Choice America supports the legal framework established in Roe v. Wade. Regarding the right to abortion in the third trimester, Roe allows for restrictions on post-viability abortion so long as they contain adequate exceptions to protect the woman’s life and health. However, many states have bans with inadequate exceptions, no exceptions at all, or define viability as occurring at a particular point in pregnancy. A state may not prohibit abortion prior to viability, which is that point at which a fetus is capable of "meaningful life" outside a woman’s body. Roe v. Wade, 410 U.S. 113, 163 (1973). Because viability is a point that varies with each pregnancy, states may not declare that it occurs at a particular gestational age.

NARAL Pro-Choice America does not oppose restrictions on post-viability abortions, such as Maryland’s, that contain adequate exceptions to protect the life and health of the woman.


Biased Counseling

No state measure.

Mandatory Delays

No state measure.

Insurance Coverage for Abortion

Supports Insurance Coverage of Contraception

Maryland law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception.

What is required?  If a health-insurance plan provides coverage for prescription medication, it must provide coverage for any Food and Drug-Administration-approved prescription contraception and any medically necessary exam associated with the use of contraception.

To which insurance plans does the law apply?  Insurance plans, nonprofit health service plans, and health maintenance organization (HMO) contracts that provide coverage for prescription medication.

Does the law provide additional protections for women?  Yes.  Insurers may not impose a different copayment or coinsurance for contraceptives than that imposed on any other prescription medication.

Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage?  Yes.

To whom does the refusal clause apply?  Religious employers for whom contraceptive coverage conflicts with their bona fide religious beliefs and practices.

What does the refusal clause allow?  A religious employer may require issuers of its health-insurance plans exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  Yes.  By failing to define the term "religious employer," the law’s refusal clause inappropriately includes a wide range of entities that perform non-religious functions in the public sphere.

Does the law require the refusing entity to notify the persons affected?  Yes.  An employer exercising a refusal clause must provide employees reasonable and timely notice of the exclusion.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  No.

MD. Code Ann., Ins. § 15-826 (Enacted 1998).


Improves Insurance Coverage of Contraception

Coverage of All Unique FDA-Approved Products

What is required?  Maryland law builds upon federal law by requiring that insurers cover all unique therapeutic products for contraception without cost-sharing, including those available over the counter without a prescription.  If a prescriber deems a certain contraceptive drug or device medically necessary for a patient, the insurer must cover it.

To which insurance plans does the law apply?  All health-insurance plans issued or delivered in the state that provide contraceptive coverage.  The law does not apply to grandfathered health plans.  Grandfathered plans are group plans that were created or individual plans that were purchased on or before March 23, 2010 and have not made significant changes.

Does the law contain a refusal clause, allowing certain employers and/or insurers to refuse to provide or pay for contraceptive coverage?  No.

  

Has a court considered the constitutionality of this law?  No.

2016 Md. Laws Ch. 437; 2016 Md. Laws Ch. 436.


Improves Insurance Coverage of Contraception

Maryland law requires health-insurance plans cover dispensing of a 12-month supply of prescription contraceptives.

Md. Code Ann., Insurance § 15-826.1 (enacted 2018); 2018 Md. Laws Ch. 450.


Improves Insurance Coverage of Contraception

No Co-Pay for Contraception

Maryland prohibits insurers from imposing any cost-sharing on all unique FDA-approved contraceptive products.

2016 Md. Laws Ch. 437. 2016 Md. Laws Ch. 436.


Abortion Coverage for Low-Income People

Restricts Low-Income Women’s Access to Abortion

Maryland allows women eligible for state medical assistance for general health care to obtain public funds for abortion services if:  (1) continuation of the pregnancy is likely to result in the woman’s death; (2) the woman is a victim of rape, incest, or a sexual offense reported to a law-enforcement, public health, or social agency; (3) the fetus is affected by a genetic defect or serious deformity or abnormality; (4) abortion is medically necessary because there is substantial risk that continuation of the pregnancy could have a serious and adverse effect on the woman’s present or future physical health; or (5) continuation of the pregnancy is creating a serious effect on the woman’s mental health and if carried to term there is substantial risk of serious or long lasting effect on the woman’s future mental health. Md. Regs. Code tit. 10, §§ 09.02.04(G); Md. Medical Assistance Program, Physician Servs. Provider Fee Manual, p. 55 (Jan. 2019), at https://mmcp.health.maryland.gov/Documents/Professional%20Services%20Provider%20Manual%202019%20effective%201.1.19%20finalv.pdf.


Young People & Abortion

Parental Notice

Maryland law restricts young women’s access to abortion.

Is the law enforceable?  Yes.

Who is considered a minor?  A young woman under the age of 18.

What is required – parental consent or parental notice?  Notice.

Who must be notified?  One parent.

Are there other trusted adults who may be notified instead?  No.

What is the process for providing notification?  A young woman may not obtain an abortion unless the attending physician gives notice to a parent, unless the young woman does not live with a parent and a reasonable, but unsuccessful effort has been made to give notice to a parent.  A postal receipt showing that mail was sent by certified mail to the last known address of a parent is conclusive evidence of notice or a reasonable effort to give notice.

May the parental mandate be waived if a young woman is a victim of rape or incest?  No.

May the parental mandate be waived if a young woman is a victim of child abuse?  No.

May the parental mandate be waived if a young woman’s health is threatened?  Yes.  A physician has discretion to provide an abortion when, "in the professional judgment of the physician," parental "[n]otification would not be in the best interest of the minor."

May the parental mandate be waived under any other circumstances?  Yes.  There are three situations in which a physician has discretion to provide the procedure without parental notification.  The physician would make the professional judgment that either:  (1) notice to the parent may lead to physical or emotional abuse of the minor; (2) the young woman is mature and capable of giving informed consent; or (3) notice would not be in the best interest of the young woman.

Are there other significant requirements under the law?  No.  The law does not contain a judicial-bypass procedure.

Has a court considered the constitutionality of this law?  No.

Other information about the law:  None.

Md. Code Ann., Health-Gen. § 20-103 (Former Statute Enacted 1967; Current Statute Enacted 1982; Last Amended 1991); Md. Code art. 1, § 24 (Enacted 1973; Last Amended 2002).


Family-Planning Policies

Insurance Coverage & Contraception

No state measure.

Contraception Coverage for Low-Income People

Supports Low-Income Women’s Access to Contraception

MEDICAID COVERAGE OF EMERGENCY CONTRACEPTION (EC)

Maryland provides Medicaid coverage of emergency contraception without a prescription.

Maryland Medicaid Program Family Planning Waiver Services — Factsheet #3 (May 2017), at https://mmcp.health.maryland.gov/Documents/Factsheet3_Maryland%20Family%20Planning%20Waiver%20Program%20(1).pdf; Maryland Dept. of Health Coverage for Over-The-Counter (OTC) Pharmacy Products (Mar. 2018), at https://mmcp.health.maryland.gov/pap/docs/OTC%20Exception%20List%20version%203.Alpha.Final.pdf.


Improves Insurance Coverage of Contraception

Maryland law requires health-insurance coverage through the family planning program and the Maryland Children’s Health Program to provide benefits that allow for dispensing a 12-month supply of prescription contraceptive drugs at one time.

Md. Code Ann. Health-Gen §15-148 (2018).


Supports Low-Income Women’s Access to Contraception

Maryland provides increased access to reproductive-health-care services through a State Plan Amendment (SPA) to its Medicaid program. The SPA allows the state to cover family-planning services for women and men with incomes at or below 259 percent of the federal poverty level who do not qualify for any other category of Medicaid. Additionally, enrollees must be (1) U.S. citizens or persons who meet the state’s defined immigration requirements and (2) Maryland residents.

Beneficiaries of family-planning coverage available through the waiver are not required to pay premiums or co-payments for covered services.  Covered services include office visits; laboratory tests; contraceptive methods and devices, including emergency contraception; and voluntary sterilization.

Maryland previously increased access to reproductive-health-care services through a waiver.

Maryland State Plan, MD-18-0005, at  https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/MD/MD-18-0005.pdf.  


Emergency Contraception

Maryland law ensures that sexual-assault survivors receive access to emergency contraception (EC) in hospital emergency rooms.  As part of the minimum standards for the examination and treatment of a sexual-assault survivor, a physician or other health-care provider must offer a sexual-assault survivor EC and provide EC to her upon request.

Md. Code Regs. 10.12.02.03.


Other Important Issues

Clinic Protections

Clinic Protections

A person who physically detains an individual or obstructs, impedes, or hinders an individual’s passage, with the intent to prevent the individual from entering or exiting a medical facility, is guilty of a misdemeanor and may be fined up to $1000, imprisoned for up to 90 days, or both.  Md. Code Ann., Crim. § 10-204 (Enacted 2002).


Refusals & Guarantees

Refusals of Medical Care

ABORTION REFUSAL CLAUSE

Maryland allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  Allows individuals to refuse to participate in, or refer to any source for, medical procedures that result in an abortion.  Allows hospitals to refuse to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in an abortion.  The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health-care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No, however, the law does not shield an individual from liability if their refusal to refer results in a life-threatening situation.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Has a court considered the constitutionality of this law?  A court has interpreted this law’s use of "refer" to apply only to the refusal to refer patients and not to protect a hospital’s refusal to send residents outside of the hospital to gain clinical experience in abortion services.  St. Agnes Hosp. of Baltimore, Inc. v. Riddick, 748 F. Supp. 319 (D. Md. 1990).

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1982; Last Amended 1991).

ARTIFICIAL INSEMINATION REFUSAL CLAUSE

Maryland allows certain individuals or entities to refuse to perform or participate in artificial insemination procedures.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  Allows individuals to refuse to participate in, or refer to any source for, medical procedures that result in artificial insemination.  Allows hospitals to refuse to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in artificial insemination.  The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although Maryland law requires health insurance plans that cover prescription medication to provide equitable coverage for contraception, certain employers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply?  Religious employers for whom contraceptive coverage conflicts with their bona fide religious beliefs and practices.

What does the refusal clause allow?  A religious employer may require issuers of its health-insurance plans exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  Yes.  By failing to define the term "religious employer," the law’s refusal clause inappropriately includes a wide range of entities that perform non-religious functions in the public sphere.

Does the law require the refusing entity to notify the persons affected?  Yes.  An employer exercising a refusal clause must provide employees reasonable and timely notice of the exclusion.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  No.

Md. Code Ann., Ins. § 15-826 (Enacted 1998).

STERILIZATION REFUSAL CLAUSE

Maryland allows certain individuals or entities to refuse to perform or participate in sterilizing procedures.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  Allows individuals to refuse to participate in, or refer to any source for, medical procedures that result in sterilization.  Allows hospitals to refuse to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in sterilization.  The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health-care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).


Counseling & Referral Bans

No state measure.

Everyone should be able to decide if, when, how, and with whom they start or grow a family.

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