For Physicians. By Physicians.
For Physicians. By Physicians.
The recent decision by the Centers for Medicare & Medicaid Services (CMS) to rescind its 2022 guidance on the Emergency Medical Treatment and Labor Act (EMTALA) has significant, albeit still evolving, practical implications for Ob/Gyns and emergency medicine physicians. EMTALA, a cornerstone of emergency care since 1986, mandates that Medicare-participating hospitals with emergency departments provide a medical screening examination to any individual who comes to the emergency department seeking care, and if an emergency medical condition exists, provide stabilizing treatment or an appropriate transfer, regardless of their ability to pay or insurance status. The core principle remains that patients in emergent situations are entitled to stabilizing care.
The 2022 CMS guidance was issued in the wake of the Dobbs v. Jackson Women’s Health Organization Supreme Court decision, aiming to clarify EMTALA’s application, particularly concerning pregnant patients experiencing emergency medical conditions. This guidance explicitly stated that if an abortion was the necessary stabilizing treatment for an emergency medical condition—such as ectopic pregnancy, severe preeclampsia, or complications of pregnancy loss—then EMTALA required that care to be provided, even in states with restrictive abortion laws. It sought to reinforce the federal supremacy of EMTALA in such scenarios, providing a measure of clarity and protection for providers navigating complex legal landscapes.
Of note, the recent rescission of this 2022 guidance by CMS, effective May 29, 2025, primarily reflects a shift in federal administrative policy rather than a change in the underlying EMTALA statute itself. While CMS asserts that EMTALA continues to be enforced and protects individuals with emergency medical conditions, including pregnant patients, the removal of the explicit clarification regarding abortion as stabilizing care creates significant ambiguity for frontline physicians. This action places Ob/Gyns and emergency medicine physicians in a heightened state of uncertainty, especially in states where abortion is heavily restricted or banned, and where the definition of “life-saving” exceptions may be narrower than EMTALA’s “stabilizing” standard.
From a practical perspective, this rescission means that Ob/Gyns and emergency medicine physicians may feel increased apprehension about providing medically necessary abortion care for emergency conditions if such care could be interpreted as violating state law. While professional organizations like ACEP (American College of Emergency Physicians), ACOG and various state attorneys general continue to affirm that EMTALA’s obligations persist, and that physicians must provide necessary stabilizing care regardless of state restrictions, the lack of explicit federal backing from CMS adds a layer of legal risk and confusion. Physicians may find themselves caught between their ethical obligation to provide comprehensive, evidence-based care and the fear of legal repercussions, including potential criminal charges or loss of license, in states with conflicting laws.
Physicians will continue to prioritize patient well-being, adhering to EMTALA’s mandate to stabilize emergency medical conditions. However, the onus is now more heavily on individual providers and their healthcare systems to understand and interpret the interplay between federal EMTALA requirements and evolving state laws, ensuring that medically appropriate care is not delayed or denied due to legal uncertainty.
CMS Statement on Emergency Medical Treatment and Labor Act (EMTALA) | CMS
EMTALA – Society for Maternal-Fetal Medicine
ACOG Statement on EMTALA Protections in Idaho | ACOG
ACEP Reaffirms Emergency Physicians’ Duty to Uphold EMTALA, Provide Stabilizing Care in Emergencies
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