State of telehealth medication abortion (TMAB)

Advanced practice clinicians (APCs) are healthcare providers with advanced training and education, encompassing physician assistants/associates (PAs), licensed midwives, and advanced practice registered nurses (APRNs). The APRN category includes nurse practitioners (NPs), certified nurse midwives (CNMs), and clinical nurse specialists (CNSs). The scope of practice for these professionals is extensive, but the ability to provide TMAB is governed by overlapping state-specific licensing laws and regulations. Assessing an APC's capacity to provide a particular service requires careful consideration of state statutes, regulatory interpretations, and any requirements for a valid patient-provider relationship, as well as any necessary supervision or collaborative agreements. Even in states where an APC cannot provide TMAB directly, they may still be able to support abortion care via telehealth through counseling and other parts of the episode of care.

The provision of telehealth for medication abortion is provided entirely through virtual care. This can be site-to-site or direct-to-patient.

The provider and patient are located in different places while using either a secure video-conferencing platform, audio platform, or a secure messaging system (asynchronous care). This is a fully remote model and oftentimes, the patient is located outside of a clinical setting, such as in their home.

The right to receive abortion care is protected by state statutes or state constitutions, and other laws and policies, including “shield laws,” that create additional access to abortion care.

State-mandated Bans specifically restricting the provision of TMAB.

The provision of telehealth for medication abortion care can be provided by telehealth in part, but not in entirety, because of state-mandated policies requiring a patient to have an in-person interaction.

State-mandated requirements, typically including numerous in-person visitation requirements, that practically inhibit the ability of a provider to utilize telehealth for any part of a patient’s abortion care process, regardless of the healthcare provider’s medical recommendation.

A state-mandated requirement that an abortion-seeker is physically present with their clinician during a certain stage of the abortion care process, regardless of the healthcare provider’s medical recommendation.

Informed Consent for telehealth is a legal requirement in many jurisdictions, with specific mandates often dictated by state medical boards and insurance statutes. Legally, it serves as a risk management tool that establishes the "standard of care" for virtual interactions.

Legal protections, including by executive order alone, that create state-specific protections for providers of abortion care, including abortion and telehealth for medication abortion providers, supporters, funds etc. treating and/or supporting a patient physically located in the shielding state.

Legally binding agreements between states that allow healthcare professionals to practice in multiple jurisdictions without needing to repeat a separate licensure process for each state. These agreements function similarly to a driver's license, where a credential issued in a professional's home state is recognized and honored by other participating member states. While they do not create a "national license," they establish a streamlined framework through either mutual recognition or expedited licensure pathways. In the nursing model, a single multistate license granted by a primary state of residence provides the legal privilege to practice across all other compact members. The physician model, using the Intestate Medical Licensure Compact (ILMC), uses an expedited process that centralizes credential verification to significantly accelerate the acquisition of separate licenses in additional states.

The Interstate Medical Licensure Compact (IMLC) offers an expedited pathway for qualified physicians to obtain multiple state licenses through a centralized application process. By streamlining the verification of a physician's primary credentials, the IMLC reduces the administrative time required to expand a medical practice across state lines.

The Nurse Licensure Compact (NLC) offers a mutual recognition model that allows a nurse to hold one multistate license in their primary state of residence. This single credential grants the legal privilege to practice in all other participating compact states without needing additional applications or fees. By bypassing traditional, lengthy application hurdles, these compacts ensure that qualified professionals can provide care across state lines with much greater efficiency.

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has guidelines that all state Medicaid programs must follow, but each state has flexibility in designing and administrating its programs. As a result, eligibility requirements and benefits vary widely from state to state.

Medication abortion typically involves taking two different medications, Mifepristone and Misoprostol, to terminate a pregnancy up to 12 weeks. MAB care can be done through an in-person clinical visit, all virtual telehealth, hybrid-telehealth or people can choose to use MAB to self-manage their abortion.

A state-mandated requirement that an abortion-seeker undergoes blood testing and treatment for Rhesus (Rh) factor, a protein found in red blood cells, regardless of the healthcare provider’s medical recommendation.

The provider and patient are located in different clinical sites using a secure video-conferencing platform for patient counseling, medication administration or dispensing, or supervising drug ingestion.

Telehealth enables health care clinicians to treat patients virtually without an in-person appointment. Patients can connect directly with a healthcare clinician from any location and this can be done in a variety of modalities ways, including via live synchronous video, synchronous audio-only, and asynchronous store-and-forward modalities, such as video (“synchronous”), the phone, secured chat (“asynchronous”), and other telecommunications. This can be delivered direct-to-patient, site-to-site, or via hybrid in-person/virtual care.

Legal protections, including by executive order alone, that create state-specific protections for providers of abortion care, including abortion and telehealth for medication abortion providers, supporters, funds etc. treating and/or supporting a patient physically located in the shielding state and patients physically located in a different state.

Generally refers to a patient’s use of a phone and/or video with a provider for some or all of the interactions to prescribe and receive medication abortion. TMAB can be direct-to-patient, site-to-site, or through a hybrid in-person/virtual care experience using different modalities.

A state-mandated requirement that an abortion seeker receive an ultrasound before abortion care, regardless of the healthcare provider’s medical recommendation. This requirement can be explicit or implicit.