What is EMTALA?

What is EMTALA?

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law requiring hospital emergency departments to provide “stabilizing treatment” to patients experiencing an emergency health condition, including during pregnancy, regardless of the patient’s insurance status or ability to pay. The U.S. Department of Health and Human Services (HHS) is responsible for assuring EMTALA compliance in all hospitals that receive Medicare funding. Nonetheless, the stories of people denied emergency abortion care, even in so-called “protective” states, continue to mount nationwide. This fact sheet breaks down how EMTALA enforcement from HHS should function.

Before denials of care

Before denials of care

Among other requirements, EMTALA mandates that hospitals with emergency departments:

• Provide a medical screening examination to any individual who comes in to the hospital emergency room to determine if they have an emergency medical condition;
• Stabilize the person experiencing an emergency within the hospital’s capabilities;
• If the hospital doesn’t have the medical capability to stabilize the person, provide an appropriate transfer to a facility that does have the capability to treat;
• Document the care, examination, and transfer of all individuals who seek emergency treatment.

The Centers for Medicaid and Medicare Services (CMS), an agency within HHS, enforces EMTALA obligations through Conditions of Participation (CoPs). Any hospital that accepts Medicare or Medicaid funding signs a Medicare Provider Agreement, which includes a requirement to adhere to EMTALA.

In order to comply with EMTALA and the CoPs, hospitals must adopt and enforce internal policies and procedures that codify these requirements. Hospitals must also maintain a list of physicians who are on call to provide further evaluation and/or the treatment necessary to stabilize an individual with an emergency medical condition.

After denials of care

After denials of care

HHS learns about potential EMTALA violations from external parties. A common example is through administrative complaints, which can be filed by anyone, including individuals who experienced care refusal. CMS has a web portal specifically for patients, healthcare workers, or others to file EMTALA complaints.

Based on the details of the complaint, CMS investigators will assess a hospital’s compliance with EMTALA under the hospital’s Medicare Provider Agreement. Generally, CMS will work with a local State Survey Agency in the state where the alleged violation occurred to further its investigation.

As part of the investigation, investigators might reach out to patients and other people identified in hospital records to verify allegations made in the complaint and find additional information. The process can take weeks, months, or even years, depending on the nature and complexity of the complaint.

Finding violations

Finding violations 

After the investigation is completed, CMS decides if a hospital violated EMTALA. If CMS determines that there was an EMTALA violation, the violating hospital has up to 90 days to submit a remediation plan and start implementing corrective actions. The only sanction CMS can impose for an EMTALA violation is termination from the Medicare program if the hospital is unwilling or unable to correct the violation or otherwise come into compliance.

Additionally, CMS can refer cases to the HHS Office of the Inspector General (OIG), which has the authority to impose fines against hospitals for violations of EMTALA. OIG may also exclude specific providers from participation in Medicare and state health care programs.  If OIG determines that fines are appropriate, it communicates that to the provider in an informal process and, in most cases, negotiates a settlement. If a settlement cannot be reached, OIG may start a formal administrative process, which moves the case to litigation before an Administrative Law Judge (“ALJ”). If the ALJ upholds the OIG’s recommended fines against the hospital, the hospital may appeal the decision to an appellate administrative panel and then to federal court.

Center EMTALA complaints

How has HHS responded to the Center’s EMTALA complaints?

The Center for Reproductive Rights has filed EMTALA complaints on behalf of pregnant patients in multiple states who were refused emergency abortion care, including:

• Jaci Statton, who needed abortion care as the stabilizing treatment for her condition. Although her OB-GYN advised Jaci that an abortion was medically necessary because she had a partial molar pregnancy—which can lead to severe bleeding, cancer, high blood pressure, preeclampsia and death—the hospital refused to treat her due to Oklahoma’s restrictive abortion laws. She ultimately traveled out of state to get the abortion care she needed, despite the risks to her health and life.
• Kelsie Norris-De La Cruz, who had an ectopic pregnancy. Kelsie was discharged by a Texas hospital without treatment or transfer, even against the recommendation of the emergency room doctor. Hours later, Kelsie sought a second opinion from another OB-GYN who diagnosed the ectopic pregnancy and rushed her into emergency surgery to save her life. She lost one of her fallopian tubes, leaving her future fertility compromised.
• Kyleigh Thurman, who also had an ectopic pregnancy. Kyleigh was refused treatment by a Texas hospital, despite continued vaginal bleeding and her OB-GYN and an attending hospital physician recommending abortion care. Days later, the hospital agreed to treat her, but the care came too late; Thurman’s ectopic pregnancy ruptured. She too lost one of her fallopian tubes, leaving her future fertility compromised.

Despite these egregious cases, accountability remains elusive. HHS declined to find an EMTALA violation in Jaci Statton’s case. The complaint filed for Kelsie Norris-De La Cruz is still pending. Only Kyleigh Thurman has received a modicum of justice, with HHS citing the Ascension Seton Williamson Hospital for violating EMTALA when it refused to provide care for her ectopic pregnancy. Ascension remains in the Medicare program and, as far as we are aware, was not fined.

Trump admin EMTALA enforcement

How has the Trump administration addressed EMTALA enforcement?

In March 2025, the Trump administration dismissed a legal challenge initially brought by the Biden administration against Idaho. The challenge claimed that the state’s abortion ban violates EMTALA because it lacks a health exception. Since the dismissal, doctors have been even more hesitant to provide abortion care, even in dire situations.

Furthermore, in June 2025, the Trump Administration rescinded federal guidance on emergency abortions, amplifying confusion about compliance requirements. While HHS is still legally required to enforce the EMTALA statute, the Trump administration’s refusal to provide clarity on emergency abortion care only serves to chill care for pregnancy complications and ultimately harms patients nationwide.

Key takeaways

Key takeaways

Despite the current administration’s indifference toward pregnant people experiencing medical emergencies, EMTALA is still the law of the land. Health care providers are mandated to provide stabilizing treatment—including abortion care—under EMTALA, and HHS must assure robust compliance. The Center will continue to hold HHS accountable for its enforcement obligations to ensure that individuals who seek emergency obstetric and abortion care receive the lifesaving services that they need. Learn more about our most recent EMTALA complaints.