Introduction

Abortion-related laws in Maryland reflect a commitment to protecting reproductive rights and abortion access. Maryland’s policies extend beyond legal protections for abortion to encompass measures aimed at facilitating access to reproductive healthcare. These progressive laws and policies have made the state of Maryland a safe haven for abortion care.

It is important to note that laws and policies surrounding abortion are rapidly evolving, both in Maryland and across the United States. The information in this section is current as of April 2024.

Learning Outcomes

• Describe two recent legislative changes in Maryland that have protected or expanded abortion access.
• Explain the Abortion Care Access Act and how it impacts APC practice in Maryland.
• Describe parental notification requirements for minors receiving an abortion in Maryland and list exemption criteria.

Maryland Law and Policy Highlights

Abortion is legally protected in Maryland up to fetal viability. Thereafter, abortion remains legal only if necessary to protect the health or life of the pregnant person or if the fetus is affected by a genetic defect or serious abnormality^[1]. Viability is defined as when, in a clinician’s best medical judgment, there is a reasonable likelihood of the fetus’ sustained survival outside the uterus.

Abortion Protections in Maryland

Maryland has enacted comprehensive legal protections for abortion access, including:

• Statutory abortion protections: Maryland law protects abortion up to fetal viability and at any time during the pregnancy if necessary to protect the health or life of the pregnant person or in the case of severe fetal abnormality¹. Marylanders will have the opportunity to enshrine the right to reproductive freedom in the state constitution by voting in favor of a constitutional amendment in the 2024 general election^[2]. If passed, this would provide even stronger protections for abortion in Maryland.
•  Medicaid coverage: Maryland is one of only 17 states in which state Medicaid funding covers abortion in most cases. By providing Medicaid funding for abortion, Maryland ensures that individuals with low incomes have equitable access to comprehensive reproductive healthcare services regardless of their financial circumstances^[3][4].
• Private insurance coverage: The Maryland Abortion Care Access Act, passed in 2022, requires certain state-regulated insurance providers to cover abortion services without deductible or other cost-sharing requirements⁴.
• Expanded qualified healthcare providers of abortion: Another component of the Maryland Abortion Care Access Act removed “physician-only” requirements to allow other qualified providers including nurse practitioners, physician assistants/associates, certified nurse midwives, and licensed certified midwives for whom abortion is within the scope of the individual’s license or certification to provide abortion⁴.
• Interstate shield: The Reproductive Health Protection Act was passed in 2023 as part of the Reproductive Freedom bill package. It protects Maryland healthcare providers who perform abortion from out-of-state legal prosecution and safeguards the ability of healthcare providers to offer abortion services without fear of retaliation or interference^2,[5].
• Health record data privacy: Also passed as part of the Reproductive Freedom bill package in 2023, new legislation provides additional privacy protections for electronic health record data to reduce legal risk for out-of-state patients seeking abortion care in Maryland^2,[6].
• Reproductive health services plan at higher education institutions: Beginning on August 1, 2024, Maryland law will require public higher education institutions to have a plan to provide or refer for comprehensive sexual and reproductive health services, including abortion^2,[7].
• Protection against clinic violence: Maryland law protects access to abortion clinics by prohibiting interference with entering and exiting a facility^[8].
• Maryland has no state-mandated counseling, waiting period, or medically unnecessary ultrasound requirements.

Abortion Restrictions in Maryland

While Maryland boasts robust legal protections for abortion, some restrictions remain:

• Parental notification requirement for minors: Maryland law mandates a parent or guardian to be notified of a minor’s abortion. However, the qualified provider may perform an abortion without notifying a parent or guardian if the minor does not live with a parent or guardian and the qualified provider’s efforts to notify them have failed. The qualified provider may also perform the abortion without notice to a parent or guardian if, in the professional judgment of the qualified provider:
  • Notice to the parent or guardian may lead to physical or emotional abuse of the minor;
  • The minor is mature and capable of giving informed consent to an abortion; or
  • Notification would not be in the best interest of the minor^[9].

Minors in Maryland may consent for other reproductive health services including pregnancy testing, sexually transmitted infection testing and treatment, and contraception without the involvement of a parent or guardian^[10]. While many minors choose to involve a parent in this decision-making, minors can access these services confidentially without parental notification or permission.

• Targeted regulation of abortion providers – Facility and transfer requirements: Abortion clinics in Maryland are subject to special facility and transfer agreement requirements. Targeted Regulation of Abortion Providers, or TRAP laws, often impose logistical and administrative burdens that hinder the establishment and operation of new clinics and thus limit access to abortion services, particularly in underserved areas^[11].

Exercise:

Use these Interactive Maps from Guttmacher Institute and Center for Reproductive Rights to explore abortion laws in the states that surround Maryland.

Center for Reproductive Rights Interactive Map

Guttmacher Institute Interactive Map

Advanced Practice Clinicians as Abortion Providers

Advanced practice clinicians (APCs) include nurse practitioners (NPs), physician assistants/associates (PAs), certified nurse midwives (CNMs), and licensed certified midwives.

APCs can competently provide all components of medication and aspiration abortion with complication rates comparable to those of physician abortion providers^[12][13][14]. Research supports the adoption of policies that allow APCs to perform aspiration abortion procedures. APCs are already competent sources of primary and reproductive healthcare, particularly in medically underserved and rural settings. In states without laws prohibiting APCs from providing abortion, these clinicians play an essential role in increasing patient access to timely and compassionate abortion care in areas where it is needed most^[15]. Despite this, their involvement in abortion care is often limited by restrictive state laws (i.e. physician-only laws), lack of training opportunities, and institutional policies.

This topic is discussed again in TEACH Chapter 10: Becoming a Provider, Leader, and Advocate.

Legal and Regulatory Considerations for APC Abortion Providers in Maryland

The Abortion Care Access Act was enacted in 2022 with the goal of protecting and expanding access to abortion in Maryland. This legislation removed Maryland’s physicians-only law to allow other qualified providers including NPs, PAs, CNMs, and licensed certified midwives, within the scope of their license and certification, to provide abortion⁶.

Maryland has a shortage of abortion providers. Data from 2020 shows that approximately ⅔ of Maryland counties don’t have an abortion provider^[16][17]. Removing “physician-only” laws expand the pool of qualified abortion providers and serves as an important way to expand access in states like Maryland where abortion remains legal^[18].

Maryland boasts a thriving community of practicing APCs who play integral roles in delivering high-quality primary and reproductive care to patients across various healthcare settings. As abortion legislation across the nation becomes more restrictive, APCs in Maryland have an important role to play in addressing healthcare disparities and expanding access to abortion.

Physician Assistant/Associate (PA) Practice in Maryland

PAs play a critical role in addressing healthcare shortages in Maryland. The recent passage of the Maryland PA Modernization Act of 2024 (H.B. 806) addresses the changing landscape of healthcare delivery and is a significant step forward in removing barriers to PA practice.

Once effective on October 1, 2024, the Physician Assistant Modernization Act ^[19] will advance several key changes to PA regulation and practice. Some highlights include replacing longstanding delegation agreements with collaboration agreements, removing PAs as agents of physicians, thus allowing PAs to practice under their education, training, and experience, waiving approval of advanced procedure for PAs with more than 7000 hours of clinical practice and PAs practicing in certain settings, and requiring updates to core and advanced duties.

This year, PAs will work collaboratively with the Maryland Board of Physicians to revise the current advanced procedures list by January 2025. Advanced procedures are defined by the Board as medical acts that require additional training beyond the basic PA education program. The list currently includes several gynecologic procedures such as endometrial biopsy and long-acting reversible contraception (LARC) insertion/removal. The upcoming revision of this list will be key for PAs seeking to provide reproductive health services to patients without potential delays in care.

Nurse Practitioner (NP) and Certified Nurse Midwife (CNM) Practice in Maryland

Maryland is a state with full practice authority for nurse practitioners and certified nurse midwives. Full practice authority refers to state practice and licensure laws which allow NPs and CNMs to autonomously practice to the full extent of their education, clinical training, and board certification under the licensure authority of the Maryland Board of Nursing without supervision or collaborative agreement requirements^[20][21].

Medicaid Billing for Abortion Services in Maryland

While Maryland Medicaid should cover abortion services in most circumstances, navigating eligibility and billing can be challenging. The Maryland Department of Health’s Abortion Services fact sheet provides information regarding how to verify a Medicaid participant’s eligibility for abortion coverage and how to submit claims for abortion services to the Medicaid fee-for-service program. 

Malpractice Coverage for Abortion Services

Securing affordable liability insurance is a significant obstacle for many clinicians who wish to provide abortion care. Abortion services are often bundled with general obstetrics and gynecology coverage, despite significantly lower complication rates. Clinicians without coverage for abortion services under their institution’s liability insurance can seek supplemental malpractice insurance.

This topic is discussed again in more detail in TEACH Chapter 10: Practice Integration.

Professional and Legal Resources

Laws and policies related to abortion and professional practice will continue to evolve. Participating in professional organizations and groups with expertise in abortion and reproductive health, such as those listed here, is an essential way to remain knowledgeable of policy changes and engaged in advocacy efforts.

• National Abortion Federation (NAF)
• Society of Family Planning (SFP)
• Reproductive Health Access Project (Advanced Practice Clinician Cluster and Mid-Atlantic Cluster)
• Nurses for Sexual and Reproductive Health (NSRH)
• If/When/How: Lawyers for Reproductive Justice
• Abortion Defense Network
• American College of Obstetricians and Gynecologists (ACOG)
• Association of Physician Associates in Obstetrics and Gynecology (APAOG)
• Maryland Academy of Physician Assistants (MdAPA)
• American College of Nurse-Midwives (ACNM)
• National Association of Nurse Practitioners in Women’s Health (NPWH)
• Nurse Practitioner Association of Maryland (NPAM)
• American Association of Nurse Practitioners (AANP)

State licensing boards are also important resources for practice information.

• Maryland Board of Nursing
• Maryland Board of Physicians
  • Maryland Board of Physicians Advanced Procedures List

Resources for Maryland Patients

• Baltimore Abortion Fund – Funding and Practical Support
• Baltimore Doula Project – Abortion Support

Additional patient resources are found throughout the TEACH curriculum including in Chapter 2: Counseling and Informed Consent under the subsections Making Referrals and Post-Procedure Support.

Suggested Reading

• Jenkins J, Pitney C, Nuzzo M, Eagen-Torkko M. Midwifery and APRN Scope of Practice in Abortion Care in the Early Post-Roe Era: Everything Old Is New Again. J Midwifery Womens Health 2023;68:734–43. https://doi.org/10.1111/JMWH.13599.
• AP Toolkit: https://aptoolkit.org/