The case centers on Section 3215(c) and (j) of Pennsylvania's Abortion Control Act, which broadly prohibits state and federal Medicaid funds from paying for abortions, with narrow exceptions for life-threatening circumstances, rape, and incest. A group of abortion care providers — including Planned Parenthood Keystone, Planned Parenthood Southeastern Pennsylvania, Planned Parenthood of Western Pennsylvania, Allegheny Reproductive Health Center, Allentown Women's Center, Delaware County Women's Center, and Philadelphia Women's Center — challenged the exclusion, arguing it discriminates against women by covering all pregnancy-related care for patients who carry to term while denying coverage when a patient seeks an abortion. The providers alleged the exclusion has caused women to carry pregnancies to term against their will, forced patients to divert money needed for food, shelter, and childcare, and exposed women to significantly higher mortality risks of childbirth compared to abortion — the petition alleged the maternal mortality risk of childbirth is 14 times greater than the mortality risk for abortion.
The majority opinion, authored by Judge Wolf and decided April 20, 2026, applied the framework the Pennsylvania Supreme Court established in Allegheny Reproductive Health Center v. Pennsylvania Department of Human Services, 309 A.3d 808 (Pa. 2024), which overruled the court's 1985 Fischer decision and held that sex-based distinctions under the state Equal Rights Amendment are presumptively unconstitutional, placing the burden on the government to show a compelling interest pursued through the least intrusive means. The court held the Commonwealth failed that test. The Pennsylvania Department of Human Services had abandoned any defense of the exclusion after remand, leaving the Attorney General to intervene and argue for the Commonwealth. The court rejected the Attorney General's three asserted compelling interests — protecting fetal life, protecting women's health, and respecting the conscience rights of taxpayers who oppose abortion — finding none sufficiently compelling and concluding that, even if they were, the exclusion is not the least intrusive means of pursuing them. The court noted that state investment in maternal and infant healthcare, childcare subsidies, and programs like Women, Infants, and Children would further any interest in promoting childbirth with less coercive effect.
On the equal protection claim, the majority adopted the reasoning of the Pennsylvania Supreme Court plurality in Allegheny Reproductive II and held that the Pennsylvania Constitution's Declaration of Rights guarantees a fundamental right to reproductive autonomy, rooted in the long-recognized right to privacy in Article I and reinforced by the Equal Rights Amendment. Because the Medicaid exclusion does not operate neutrally with respect to that fundamental right — conditioning coverage on whether a pregnant patient chooses to continue or terminate a pregnancy — the court applied strict scrutiny and held the exclusion fails for the same reasons it fails under the Equal Rights Amendment. The court also held, in the alternative, that the exclusion would fail even rational basis review, finding it not rationally related to any of the asserted interests: the exclusion contains no exception even when a fetus is known with medical certainty not to survive birth, undermining any claim that it is aimed at preserving potential life.
The court permanently enjoined enforcement of the Coverage Exclusion and its implementing regulations. Judges McCullough, Covey, and Wallace dissented. Judge McCullough, joined by Judges Covey and Wallace, argued the majority erred by granting summary relief without a hearing or factfinding, that the joint stipulations of fact submitted by the non-adversarial parties could not bind the court on questions of public interest, and that the Attorney General was entitled to present evidence. Judge McCullough also disputed the recognition of a fundamental right to reproductive autonomy, arguing it lacks textual support in the Pennsylvania Constitution. Judge Wallace, joined by Judge McCullough, separately argued that genuine issues of material fact precluded summary relief and that the majority's recognition of a constitutional right to reproductive autonomy improperly stripped the legislature of its policymaking role. Judge Wojcik, joined by President Judge Cohn Jubelirer, concurred separately, tracing the right of conscience in Pennsylvania law from William Penn's 1701 Charter of Privileges through successive state constitutions to argue that the Commonwealth's coercion of a competent woman's medical decision violates a fundamental right of conscience that has existed in Pennsylvania since before the American Revolution. Judge Dumas is listed on the panel but did not author or join any separately published opinion.