California’s Only Abortion Fund Struggles to Meet Rising Demand Amid Medicaid Cuts

ACCESS Reproductive Justice has been around for more than 30 years, striving to ensure that every California woman can access abortion care regardless of her socioeconomic circumstances. The organization is California’s only statewide, standalone abortion fund, with a record of directly funding abortion and other reproductive health care while also working to dismantle systemic barriers that prevent people from making autonomous decisions about their bodies and futures.

Since its founding, ACCESS’ Direct Services program has funded more than 50,000 abortions and provided other comprehensive support to thousands of other Californians. But despite the state’s progressive reputation and significant investment in supporting women seeking reproductive health care, ACCESS is unable to meet the full unmet need for all of the callers who seek help with procedural costs, said Jessica P. Gil, ACCESS Reproductive Justice’s executive director.

After the 2022 Supreme Court Dobbs decision, many people supportive of ACCESS RJ’s mission offered nonfinancial support in other ways, such as helping with transportation or providing housing for out-of-state abortion seekers, Gil said. But that’s not where the need is, she said. Out-of-state patients coming to California to receive care increased by nearly 200 percent since June 2022. This surge has strained ACCESS’ resources.

“When Roe fell, there were folks coming out of the woodwork who were suggesting we need an underground system to get people from state to state, or saying they’d be willing to house people in their home who are here to have abortions,” she said. “But we already have the infrastructure – abortion funds have existed for decades. We already have the systems. We already have the connections to get people the care and support that they need to make the reproductive choices that they want to make. What we really need in order to continue to do our work is financial support.”

Now, with the federal government’s recent drastic Medicaid cuts, strict eligibility requirements, and prohibition of funding for Planned Parenthood health centers and other abortion providers delivering care to Medicaid patients, ACCESS is anticipating vastly increased need for financial support to cover the cost of reproductive health care services in California.

Somewhat surprisingly, ACCESS Reproductive Justice is the only abortion fund in California, compared with Texas, which has nine, Gil said. The expected burden with the new changes is particularly concerning, with a number of factors contributing to increased costs.

“Five abortion clinics have closed in California just since July due to the ‘Defund Planned Parenthood’ provision, with more likely to shutter soon,” Gil said. “That’s on top of the fact that nearly half of California counties have no abortion providers or clinics at all. We anticipate an increased need for transportation and logistical support as our callers travel farther and wait longer for available appointments, even those within the state.”

There are issues even within Santa Barbara, despite the area’s reputation for comparatively easy access to care. The impact isn’t only on those seeking abortions, Gil said.

“There’s an OB-GYN shortage within both the city and county,” she said. “That means that if you can’t find quality prenatal care, it’s going to impact your decision about whether or not you want to have your child.”

ACCESS has also seen an increased need for financial support beyond the actual medical care, Gil said, with the organization moving to help.

“The tenets of reproductive justice are that people have the human right to determine if, when, and how they become parents,” she said. “Within that framework, we believe that it’s not just about birth control, STI treatment, and abortion care, but also about people’s ability to live safe, wholesome lives. If you can’t have access to safe housing, if you don’t have access to regular food, if you are living in a surveillance state, if you don’t have access to clean water, or your children are not safe to play in their front yard because of gun violence, we see all of those as reproductive justice issues because that impacts your ability to raise your family in a safe environment with your full autonomy.”

In the last fiscal year, ACCESS RJ received more than 3,100 support requests for abortion care, gender-affirming care, and essential reproductive health care, and was able to support 1,900 of them with direct financial and practical support for procedural costs, travel, childcare, lost wages, and other barriers, providing $1.2 million in funding to people seeking care. Patients from 47 of 58 California counties were among those served, as well as people from 28 other states. Meanwhile, the organization continued to maintain 97 percent of funding going directly to patient support.

To combat these increasing issues, ACCESS RJ has launched a four-year, $4 million campaign to:

• Fully fund all procedural costs for its callers, which it estimates at $500,000 annually to bridge the gaps.

• Expand overall direct services to better reach rural communities and those facing immigration status issues, and enhance the ability to help patients seeking gender-affirming care.

• Maintain funding levels for practical support costs for all callers, with or without continued state funding beyond this fiscal year.

• Enhance technology infrastructure for efficient service delivery.

• Build organizational capacity for sustainable growth.

A rising issue also has to do with combating misinformation, as those who aren’t told about ACCESS by a medical provider often turn to a Google search or social media, where they might be misdirected by a crisis pregnancy center. Finances shouldn’t be a barrier to being able to have a choice in having a child, Gil said.

“In California in particular, there are more crisis pregnancy centers than there are abortion providers,” Gil said. “We do a lot to maintain relationships with as many providers as possible so that they know they can send folks to us as a resource. We exist to help people make decisions about their reproductive health care with as few barriers as possible. Our work is to make sure that folks can receive the science-proven care that they want and need.”