On May 29, 2025, the United States Department of Health and Human Services (“HHS”) and Centers for Medicare & Medicaid Services (“CMS”) rescinded two Quality, Safety & Oversight (“QSO”) Letters issued under the Biden administration in 2022 and an accompanying letter from the then-Secretary of HHS (collectively, the “Letters”). The Letters had set forth the Biden administration’s position that the Emergency Medical Treatment & Labor Act (“EMTALA”) requires health care providers to provide abortion services when such services are necessary to stabilize a pregnant patient with an emergency medical condition, and that EMTALA preempts any state laws with conflicting requirements, including state laws that restrict the provision of abortion services. Hall Render’s alert summarizing the Letters can be found here.
In a brief statement, CMS stated that the Letters were rescinded because they did not align with the Trump Administration’s policy goals.
The rescission of the Letters heightens uncertainty for hospitals and providers treating patients experiencing pregnancy complications and highlights the tensions between obligations imposed by EMTALA and restrictive state laws.
Background
EMTALA was enacted in 1986 to prevent patient dumping and ensure that individuals had access to emergency services regardless of their ability to pay. EMTALA requires that a patient who presents to the emergency department of a Medicare-participating hospital must receive a medical screening examination to determine whether the patient is experiencing an emergency medical condition. An emergency medical condition exists under EMTALA if (1) there are symptoms of sufficient severity that would reasonably result in serious jeopardy to the individual’s (or, with respect to pregnant patient, the patient’s or unborn child’s) health, serious bodily impairment or serious bodily dysfunction, or (2) a pregnant patient is having contractions and there is inadequate time to transfer the patient before delivery, or the transfer may pose a threat to the health or safety of the patient or unborn child. If an emergency medical condition exists, the patient must receive stabilizing care or, if stabilizing services are not within the capability of the hospital, the hospital must arrange an appropriate transfer to a facility that can provide the necessary services. Violation of EMTALA can result in exclusion from the Medicare program and civil monetary penalties.
In the wake of the United States Supreme Court’s decision in Dobbs v. Jackson Women’s Health, a number of state legislatures have passed laws that sharply restrict abortion with very limited exceptions, such as when necessary to save the life of the pregnant person, a standard that is much more stringent than that which triggers EMTALA’s obligation to provide stabilizing care.
Moyle v. United States
In Moyle v. United States, Biden’s Department of Justice (“DOJ”) sued Idaho over the state’s law prohibiting abortion except when necessary to prevent a pregnant patient’s death. DOJ claimed that Idaho’s law conflicted with, and was preempted by, EMTALA.
The Supreme Court of the United States initially agreed to hear the case, but later dismissed certiorari as improvidently granted, returning the case to the Ninth Circuit for a decision on the merits. However, on March 5, 2025, the Trump administration moved to dismiss the case, ending the injunction against enforcement of the law.
Following the Trump administration’s motion to dismiss, Idaho’s largest hospital system brought its own lawsuit challenging the state’s abortion ban and, on March 21, 2025, secured an injunction applicable only to the plaintiff health system.
The future of this litigation is currently unclear, but will be important to continue to track, as the courts are likely to play a critical role in ultimately resolving conflicting standards between EMTALA and state law.
Risk Structure Landscape
The withdrawal of the Letters highlights the continued legal and operational uncertainty facing hospitals and health care providers in states with restrictive abortion laws. The rescission of the guidance reflects a shift in federal enforcement priorities regarding the treatment of pregnant people and may weaken an EMTALA compliance argument as a defense against criminal actions under state law related to the provision of abortion in a medical emergency.
Practical Takeaways
Hospitals and emergency care providers should:
- Continue to follow their EMTALA policies that require medical screening examination and stabilizing treatment of all patients, including pregnant patients, who present to the emergency department or otherwise come to the hospital seeking care for what may be an emergency medical condition;
- Work with legal counsel to identify applicable exceptions to any state law restrictions on abortion;
- Review current standards of care involving the treatment of pregnancy-related emergencies;
- Review current hospital policies and procedures, and revise them as necessary, to ensure they are consistent with current guidance and interpretation, particularly with respect to conduct that may also be addressed by a state’s abortion laws;
- Closely monitor ongoing developments, including legal challenges expressly applying EMTALA to abortion-related services; and
- Work with professional organizations, hospital associations and state legislators to clarify obligations with respect to emergency treatment of pregnant patients.
If you have questions regarding recent federal guidance or your responsibilities to treat pregnant patients under EMTALA, or would like assistance in reviewing and updating your EMTALA policies and procedures, please contact:
- Jennifer Skeels at (317) 977-1497 or jskeels@hallrender.com;
- Katherine Kuchan at (414) 721-0479 or kkuchan@hallrender.com;
- Camilla Moreno Jimenez at (317) 429-3679 or cjimenez@hallrender.com;
- Caitlin Bell-Butterfield at (919) 228-2408 or cbell-butterfiled@hallrender.com; or
- Your primary Hall Render contact.
Special thanks to Summer Associate, Meredith Johnson-Montfort, and intern, Katelyn Howard, for their assistance in the preparation of this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
