A judge on Tuesday ruled that Nevada Medicaid must cover abortion services, a victory for abortion rights advocates who said the coverage ban violated the state’s new Equal Rights Amendment.

Clark County District Court Judge Erika Ballou ruled in favor of the American Civil Liberties Union (ACLU) of Nevada, which filed a lawsuit in August seeking to reverse the coverage ban on behalf of Silver State Hope Fund, a Nevada nonprofit that provides abortion services. Ballou has not yet issued a full order explaining her ruling.

In the 2022 election, 59 percent of Nevada voters approved the addition of an Equal Rights Amendment to the state’s Constitution. The amendment guarantees equality under the law regardless of race, color, creed, sex, sexual orientation, gender identity or expression, age, disability, ancestry or national origin. 

The ACLU had argued that Nevada Medicaid’s abortion coverage ban violated the amendment’s prohibition against sex-based discrimination.

Although abortion is legal through 24 weeks into a pregnancy in Nevada because of a 1990 referendum approved by nearly two-thirds of voters, Nevada Medicaid — the government-funded insurance program for people with low incomes — does not pay for abortions, except in cases of rape, incest or if the procedure is necessary to protect the life of the pregnant person. 

That’s because Nevada is one of 19 states to follow guidelines of the Hyde Amendment, a federal legislative provision first enacted in 1977 that restricts the use of federal funds for abortions, although it does not prevent state funds from being used to cover abortion services. According to a recent KFF research brief, 17 states use state funds to pay for abortions for women with low incomes insured by Medicaid under circumstances beyond those allowed under the Hyde Amendment.

“If you have a right to an abortion, but you don't have the financial means to get one when you need one, especially when it's necessary for your medical health, then it's almost as if you don't have the right at all,” Christopher Peterson, one of the ACLU lawyers on the case, said in an interview. “We're making sure that the right of abortion in the state of Nevada is not just letters on a page.”

The attorney general’s office, which represented the Department of Health and Human Services, opposed the lawsuit in part on the grounds that Silver State Hope Fund lacked standing and that the proper parties in the case would be women who are pregnant or are capable of becoming pregnant. Silver State Hope Fund helps cover travel, lodging and child care costs for those seeking abortions in Nevada.

The attorney general’s office also referenced arguments in a state-provided voter guide in support of the Equal Rights Amendment ballot question ahead of its placement on the 2022 ballot, which said “Nevada law already guarantees the right to an abortion, and this ballot measure will not change that right.”

The attorney general’s office declined to comment.

A group of seven Republican legislators also attempted to intervene in the case to argue that the state-based Equal Rights Amendment — which originally passed the Legislature in 2019 and 2021 — was not meant to require the state to fund abortion care. However, a judge ruled against that effort because they did not represent the Legislature as a whole.

Medicaid is a federal health insurance program that funds coverage for low-income families, qualified pregnant women and children and certain people with disabilities. Program costs are shared between the federal government and state, which is responsible for around one-quarter of program spending. As of December, Nevada Medicaid had more than 880,000 participants.

A KFF research brief estimates that as of 2022, 17 percent of women in Nevada between the ages of 15-49 were covered by Medicaid.

Updated at 12 p.m. on 3/20/24 to add a quote from Christopher Peterson.