Existing law establishes the Department of Health Care Access and Information to oversee and administer various health programs. The California Constitution prohibits the state from denying or interfering with an individuals reproductive freedom in their most intimate decisions. Existing law establishes the California Reproductive Health Equity Program within the department to ensure abortion and contraception services are affordable for and accessible to all patients and to provide financial support for safety net providers of these services.

This bill would, upon appropriation by the Legislature or the availability of funds from private sources, establish the Reproductive Health Emergency Preparedness Program (RHEPP) for the purpose of expanding and improving access to reproductive and sexual health care in emergency departments across California. The bill would require the department to award the grants and administer the RHEPP in collaboration with California-based organizations to serve as the technical assistance provider. The bill would require the department to establish minimum standards, funding schedules, and procedures for awarding grants and would specify the qualifications for the collaborating organizations. The bill would limit the permissible uses of grant funds under the program, as specified. The bill would repeal these provisions on January 1, 2030.

Existing law establishes the Department of Health Care Access and Information to oversee and administer various health programs. The California Constitution prohibits the state from denying or interfering with an individuals reproductive freedom in their most intimate decisions. Existing law establishes the California Reproductive Health Equity Program within the department to ensure abortion and contraception services are affordable for and accessible to all patients and to provide financial support for safety net providers of these services.

This bill would, upon appropriation by the Legislature or the availability of funds from private sources, establish the Reproductive Health Emergency Preparedness Program (RHEPP) for the purpose of expanding and improving access to reproductive and sexual health care in emergency departments across California. The bill would require the department to award the grants and administer the RHEPP in collaboration with California-based organizations to serve as the technical assistance provider. The bill would require the department to establish minimum standards, funding schedules, and procedures for awarding grants and would specify the qualifications for the collaborating organizations. The bill would limit the permissible uses of grant funds under the program, as specified. The bill would repeal these provisions on January 1, 2030.

Existing law establishes the Department of Health Care Access and Information to oversee and administer various health programs. The California Constitution prohibits the state from denying or interfering with an individuals reproductive freedom in their most intimate decisions. Existing law establishes the California Reproductive Health Equity Program within the department to ensure abortion and contraception services are affordable for and accessible to all patients and to provide financial support for safety net providers of these services.

This bill would, upon appropriation by the Legislature or the availability of funds from private sources, establish the Reproductive Health Emergency Preparedness Program (RHEPP) for the purpose of expanding and improving access to reproductive and sexual health care in emergency departments across California. The bill would require the department to award the grants and administer the RHEPP in collaboration with California-based organizations to serve as the technical assistance provider. The bill would require the department to establish minimum standards, funding schedules, and procedures for awarding grants and would specify the qualifications for the collaborating organizations. The bill would limit the permissible uses of grant funds under the program, as specified. The bill would repeal these provisions on January 1, 2030.

Date of Hearing: April 23, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 551

Author:(Krell) – As Amended Ver:April 10, 2025

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill establishes, upon appropriation by the Legislature or availability of funds from private sources, the Reproductive Health Emergency Preparedness Program (RHEPP) in the Department of Health Care Access and Information (HCAI) to improve access to reproductive and sexual health care in emergency departments (EDs) across California. The bill requires HCAI, in collaboration with California-based organizations, to award grants and administer the RHEPP to administer, train, and provide technical assistance to ED providers.

FISCAL EFFECT:

General Fund cost pressures to HCAI of approximately $1.54 million in fiscal year (FY) 2026-27 and $935,000 in FY 2027-28 and ongoing, for the following: an information technology support contract, at least two Office of Information Services staff, and five workforce development staff to develop the grant guide, provide ongoing monitoring and technical assistance to grantees, develop outcome data, and facilitate the program.

The costs to implement this bill would depend partly on the number and size of grants, and how many EDs or ED providers would be granted funding.

COMMENTS:

1. Purpose. Access Bridge (a program of the Bridge Center at the Public Health Institute), We are Reproductive Freedom for All CA, Training in Early Abortion for Comprehensive Healthcare (TEACH), Unite For Reproductive and Gender Equity (URGE), and VALOR are co-sponsors of this bill. According to the author:

Two years ago, Californians passed Proposition 1, enshrining the right to abortion for all Californians. California has lead the charge to protect reproductive rights and access to health care, and with attacks on reproductive freedom throughout the country, we cannot stop now. As former Chief Counsel to Planned Parenthood, I fought federal efforts to shutdown access to reproductive healthcare last time Donald Trump was President. AB 551 creates the [RHEPP] to best equip emergency departments in handling crucial reproductive healthcare, which may become necessary as patients from out of state seek healthcare in California or Californians face emergency situations due to lack of funding or access in parts of our State.

1. ED Services and Access to Reproductive Health Care. According to a 2017 Guttmacher Institute study on abortions in the U.S., an ED is the most accessible source of medical care for many pregnant people, due to a lack of health insurance and shortages of primary care providers, obstetrician-gynecologists (OB-GYNs), and reproductive health clinics. Many patients go to the ED for prenatal care, sexually transmitted infections, or sexual assault. Yet most ED providers are not well-trained in these health issues and depend on OB-GYNs, who are in increasingly short supply in many rural hospitals. Forty percent of California counties do not have an abortion provider; these regions often also have primary care and OB-GYN provider shortages.
2. Prior Legislation.
   
   AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.

AB 2490 (Petrie-Norris), of the 2023-24 Legislative Session, was substantially similar to this bill. Governor Newsom vetoed AB 2490, stating:

The 2022-23 Budget Act appropriated $120 million to HCAI to establish five programs designed to expand abortion-related care and reproductive health services across the State, including the Reproductive Health Service Corps. I appreciate the author's continued partnership and efforts to increase and improve access to reproductive care and trained providers. However, this bill is unfunded.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 8, 2025

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 551

Author:(Krell) – As Amended Ver:March 10, 2025

SUBJECT: Reproductive Health Emergency Preparedness Program.

SUMMARY: Establishes, upon appropriation by the Legislature or availability of funds from private sources, the Reproductive Health Emergency Preparedness Program (RHEPP) to expand and improve access to reproductive and sexual health care in emergency departments (EDs) across California. Specifically, this bill:

1. Establishes RHEPP in the Department of Health Care Access and Information (HCAI) for the purpose of expanding and improving access to reproductive and sexual health care in EDs across California.
2. Requires RHEPP to be administered by HCAI, in collaboration with California-based organizations, to serve as the technical assistance provider. Requires the organizations chosen to have experience providing technical assistance related to abortion, contraception, pregnancy emergencies, and pregnancy loss. Requires the organizations to oversee the recruitment and selection of participating EDs, administer the funding, and coordinate directly with hospitals that apply to participate in the program.
3. Requires funds awarded pursuant to RHEPP to be awarded to increase access to timely, evidence-based treatment of pregnancy loss and miscarriage, contraception, emergency contraception, and abortion.
4. Requires HCAI to award grants on a competitive basis. Requires HCAI to establish minimum standards, funding schedules, and procedures for awarding grants that take into consideration efforts identified to increase access to reproductive and sexual health care in participating EDs.
5. Authorizes participating EDs or outpatient clinics that lack hospital service capacity and are committed to expanding access to more comprehensive care and are receiving grants pursuant to the RHEPP to use those funds for, but are not limited to, any of the following:
   1. Providing medically accurate education, clinical guidelines and algorithms, and training tools for EDs, including materials that correct common misinformation about abortion and other reproductive health care;
   2. Supporting clinical fellowships to support internal champions working within participating EDs;
   3. Providing mentorship and coaching services for physicians and nursing and administrative leadership to support practice change;
   4. Piloting the delivery of medication abortion in participating EDs;
   5. Building internal capacity among participating ED providers to integrate medication abortion and manual or other aspiration techniques for the management of pregnancy loss and abortion; and,
   6. Developing coordinated responses between medical and nursing specialties within and outside of the participating ED.
6. Makes the provision of this bill operative upon appropriation by the Legislature or to the extent funds from private sources are made available for this purpose.
7. Specifies that the provisions of this bill are to remain in effect only until January 1, 2030, and as of that date are repealed.
8. Makes findings and declarations that EDs in hospitals are essential access points for pregnant people and people of reproductive capacity, and that RHEPP will work to improve and expand access to sexual and reproductive health care in California’s participating EDs, including abortion and evidence-based miscarriage care in EDs.

EXISTING LAW:

1. Establishes the Reproductive Privacy Act, which prohibits the state from denying or interfering with a woman’s right to choose or obtain an abortion prior to viability of the fetus, or when the abortion is necessary to protect the life or health of the woman. [Health and Safety Code (HSC) § 123460, et seq.]
2. Requires HCAI to conduct a number activities related to workforce development, health planning, and data collection and dissemination related to pharmaceutical prices and health care payments. [HSC § 127000, et seq.]
3. Establishes the California Reproductive Health Service Corps (Corps) within the Department of Health Care Access and Information to do all of the following:
   1. Administer and oversee scholarships and stipends for new reproductive health students, loan repayment for graduates who have acquired debt from attending a reproductive health professional school in the past, and other types of direct financial support for scholars, in exchange for a three-year term of obligated service in California at a corps-approved site;
   2. Pay a learning institution, teaching facility, or approved clinical training site directly on behalf of scholar, including for tuition, fees, facility costs, teaching costs, and preceptor time;
   3. Provide an annual payment for education-related costs and a monthly stipend to cover living expenses directly to a scholar. Requires the Corps to consider family size and numbers of dependents when determining stipend amounts;
   4. Offer existing reproductive health professionals an option for loan forgiveness for each year of service; and,
   5. Offer scholars stipends or reimbursement for childcare, eldercare, housing, health care coverage with coverage for mental health services, and transportation to eliminate known obstacles of educational completion for scholars.

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, three years ago, Californians passed Proposition 1, enshrining the right to abortion for all Californians in the Constitution. California has lead the charge to protect reproductive rights and access to health care, and with attacks on reproductive freedom throughout the country, we cannot stop now. As former Chief Counsel to Planned Parenthood, the author notes that she fought federal efforts to shut down access to reproductive healthcare last time Donald Trump was President. The author concludes that this bill creates RHEPP to best equip EDs in handling crucial reproductive healthcare, which may become necessary as patients from out of state seek healthcare in California or Californians face emergency situations due to lack of funding or access in parts of our State.
2. BACKGROUND.
   1. Workforce shortage. According to a March 2021 U.S. Department of Health and Human Services, National Center for Health Workforce Analysis report, “Projections of Supply and Demand for Women’s Health Service Providers: 2018-2030,” the demand for OB-GYNs is projected to exceed supply by 5,170 full time equivalents in 2030, based on current utilization patterns. The number of OB-GYNs is expected to decrease from 50,850 to 47,490 (7%), while demand is projected to increase from 50,850 to 52,660 (4%) by 2030.

The American Academy of Family Physicians recognizes termination of pregnancy up to ten weeks of gestation as an advanced core skill for family physicians. Studies have shown that first-trimester abortion training may be integrated safely and effectively into family medicine residency programs; however, most family medicine residencies have no abortion training available. In programs where abortion is an integrated part of the curriculum, residents generally report positive experiences. Residents who completed a required, opt-out abortion training program indicated that the curriculum enriched their educational experience and was consistent with the values of family medicine in providing continuity of care in a primary care setting. Another study evaluating resident experience and outcomes from a required, opt-out, comprehensive abortion training program showed interest among family medicine residents and general satisfaction with the program.

Currently, only 24 of the 461 accredited family medicine residency programs offer integrated abortion training, in part because it is not mandated by the Accreditation Council for Graduate Medical Education as it is for obstetrician/gynecologists.

• 1. Abortion Access. According to the Guttmacher Institute, in 2017, there were 1,587 facilities providing abortion in the U.S., representing a 5% decrease from the 1,671 facilities in 2014. Sixteen percent of facilities in 2017 were abortion clinics (i.e., clinics where more than half of all patient visits were for abortion), 35% were nonspecialized clinics, 33% were hospitals and 16% were private physicians' offices. Sixty percent of all abortions were provided at abortion clinics, 35% at nonspecialized clinics, 3% at hospitals and 1% at physicians' offices. In 2017, 89% of U.S. counties had no clinics providing abortions. Some 38% of reproductive-age women lived in those counties and would have had to travel elsewhere to obtain an abortion. Of patients who had an abortion in 2014, one-third had to travel more than 25 miles one-way to reach a facility.
  2. California data. According to the Guttmacher Institute, in 2017, 132,680 abortions were provided in California, though not all abortions that occurred in California were provided to state residents. There was a 16% decline in the abortion rate in California between 2014 and 2017, from 19.5 to 16.4 abortions per 1,000 women of reproductive age. Abortions in California represent 15.4% of all abortions in the U.S. There were 419 facilities providing abortion in California in 2017, and 161 of those were clinics. These numbers represent a 6% increase in clinics from 2014, when there were 512 abortion-providing facilities overall, of which 152 were clinics. In 2017, some 40% of California counties had no clinics that provided abortions, and 3% of California women lived in those counties.
  3. Increasing abortion rates. New findings from the Guttmacher Monthly Abortion Provision Study show that an estimated 1,037,000 abortions occurred in the formal health care system in 2023, the first full calendar year after the US Supreme Court’s decision in Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade. This represents a rate of 15.9 abortions per 1,000 women of reproductive age, and is a 11% increase since 2020, the last year for which comprehensive estimates are available. It is also the highest number and rate measured in the United States in over a decade.
  4. Abortion training. Abortion is normal and a common healthcare procedure, yet many healthcare professionals receive no or limited training in abortion care while in school. Only 6% of national family medicine programs guarantee their residents abortion training, and in nursing and midwifery, abortion training is even less accessible. Only 6% of national Family Medicine programs guarantee their residents abortion training, and within nursing, midwifery, and other healthcare professions, abortion training is even less accessible. Nineteen percent of Family Medicine programs in California offer opt-out abortion training as part of their residency program. California has 64 Family Medicine programs, of those 12 offer opt-out abortion training.
  5. ED services and access. According to a 2017 Guttmacher Institute study, “Abortion Incidence and Service Availability in the United States,” an ED serves as the most accessible source of medical care for many pregnant people, due to a lack of health insurance and shortages of primary care providers, OB-GYNs and reproductive health clinics. Many patients go to the ED for prenatal care, sexually transmitted infections, or sexual assault. Yet most ED providers are not well trained in these areas and depend on OB-GYNs, who are in increasingly short supply in many rural hospitals. Many Californians, especially lower-income, rural, and patients of color already struggle to obtain the full spectrum of reproductive health care near where they live. Forty percent of California counties do not have an abortion provider, creating a maldistribution of trained providers that are concentrated in the metropolitan areas of our state. These regions often also have primary care and OB-GYN provider shortages.

According to the Public Health Institute, since the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health Organization decision overturned a federal right to abortion, reproductive healthcare in the United States has devolved into chaos as large regions of the country find themselves without any local option for pregnancy and contraceptive care. This makes EDs increasingly the only open door for women facing life-altering reproductive healthcare needs. As a consequence, more and more patients are being turned away from EDs without proper care for a pregnancy emergency. This can be deadly. Amber Thurman died in Georgia in 2022 after the state’s strict abortion ban blocked medical providers from practicing life-saving care. Nevaeh Crain died after being denied care in three EDs in Texas.

These examples of preventable death and suffering underscore how ED-based reproductive healthcare stands at the forefront of reproductive health and rights in this country. As OB-GYNs grow scarce, ED providers need tools and support to provide evidence-based reproductive healthcare and change the clinical culture to scale this practice change. This can be the difference between life and death.

1. SUPPORT. This bill is cosponsored by Access Bridge, a program of the Bridge Center at the Public Health, We are Reproductive Freedom for All CA, Training in Early Abortion for Comprehensive Healthcare (TEACH), Unite For Reproductive and Gender Equity, and VALOR. The co-sponsors state that with limited options, patients are often referred to, or seek care from, emergency medical professionals who are not prepared to meet miscarriage, contraception, and abortion-related reproductive health needs. With the increase of telehealth medication abortion and self-medicated abortions, ED services also become a critical point of access. The co-sponsors note that, working directly with willing EDs, the bill would create a grant program to equip EDs to provide access to timely, evidence-based treatment of pregnancy loss and miscarriage, and abortion. RHEPP would support EDs with the necessary tools and skills building for providers, to help them better serve people who have been traditionally excluded from the healthcare system. As a result of this program EDs will be better equipped to provide pregnancy loss and miscarriage treatment, contraception, emergency contraception, medication and/or procedural abortion to patients who need it.

The co-sponsors argue EDs should be equipped to manage a wide range of reproductive health emergencies to not place an undue burden on patients without access to other modes of medical care. Further, as more states ban abortion, which includes miscarriage management, California will continue to see an increase in out-of-state patients seeking life-saving reproductive healthcare. The co-sponsors conclude, as a national leader in reproductive freedom, health, and justice California has a duty to ensure both our emergency departments and reproductive healthcare workforce are fully equipped to manage pregnancy related emergencies.

1. OPPOSITION. The California Catholic Conference (CCC) opposes this bill and states that Emergency services are an integral part of a hospital’s ministry to the community, providing critical, timely care in life-threatening situations. Calling out abortion as the only specifically required medical intervention in emergency services gives abortion disproportionate weight for clinicians examining and evaluating pregnant patients. CCC concludes that promoting specific procedures is contrary to the goals of EMTALA, which encourages EDs and physicians to use their best medical judgement for treatment and stabilization.
2. RELATED LEGISLATION.
   1. AB 40 (Bonta) would clarify in current law that “emergency services and care” includes abortion and other reproductive health services, as necessary to relieve or eliminate an emergency medical condition. Contains an urgency clause to ensure that the provisions of this bill go into immediate effect upon enactment. AB 40 was heard in the Assembly Health Committee on April 1, 2025, and passed with a vote of 12-0.
   2. AB 54 (Krell) would reaffirm that it has been, and would continue to be, lawful to cause the delivery of, or mail, ship, take, receive, or otherwise transport, any drug, medicine, or instrument that can be designed or adapted to produce an abortion that is lawful in the State of California. Sets forth provisions regarding the lack of civil or criminal liability, or professional disciplinary action, for accessing or administering mifepristone or misoprostol, among other certain conduct, on or after January 1, 2020, with this bill applied retroactively, as specified. AB 54 is pending in the Assembly Health Committee.
   3. AB 67 (Bauer-Kahan) would impose a civil penalty not exceeding $25,000 upon any person or governmental entity that violates any provision of the Reproductive Privacy Act and a civil penalty for violation of the bill’s provisions. The bill would require any costs, fees, and civil penalties collected pursuant to these provisions to be available to the office of the Attorney General upon appropriation of the Legislature for exclusive use by the Attorney General for enforcement of act. AB 67 is pending in the Assembly Judiciary Committee.
   4. AB 260 (Aguiar-Curry) would repeal unconstitutional, and delete obsolete provisions of current law relating to criminal abortion penalties. The bill would authorize the California Department of Public Health (DPH) to adopt regulations specific to mifepristone and other medication abortion drugs, including excluding those drugs from certain requirements if the drugs are no longer approved by the United States Food and Drug Administration (FDA). AB 260 would place various requirements on pharmacists related to prescribing and dispensing mifepristone or other medical abortion drugs. Prohibits DPH from taking criminal, civil, professional discipline, or licensing action against a clinic or health facility for manufacturing, transporting, or engaging in certain acts relating to mifepristone or other medication abortion drugs. The bill would also require the Department of Health Care Services (DHCS) to update provider enrollment requirements and procedures for remote service providers who offer reproductive health care services exclusively thorough telehealth modalities. AB 260 would prohibit a health care service plan contract or a group or individual disability insurance policy that covers prescription drugs from limiting or excluding coverage for brand name or generic mifepristone, regardless of its FDA approval status. The bill would also make various changes to requirements specific to healing arts practitioners who are authorized to prescribe, furnish, order, or administer certain drugs. AB 260 is pending in the Assembly Health Committee.
   5. AB 1500 (Schiavo) would require the State Department of Public Health (DPH) to partner with an organization, as specified, to update and maintain the Abortion.gov internet website. The bill would also require the internet website to include additional information on sexual and reproductive health, including, among others, sexual and reproductive health information historically relied on and made available on federal internet websites, as specified. AB 1500 is pending in the Assembly Health Committee.
3. PREVIOUS LEGISLATION.
   1. AB 2490 (Petrie-Norris) of 2024 was substantially similar to this bill. AB 2490 was vetoed by Governor Newsom, who stated in part, “I strongly support increasing the availability of and promoting access to safe and affordable reproductive health care in California. The 2022-23 Budget Act appropriated $120 million to HCAI to establish five programs designed to expand abortion-related care and reproductive health services across the State, including the Reproductive Health Service Corps. I appreciate the author's continued partnership and efforts to increase and improve access to reproductive care and trained providers. However, this bill is unfunded.”
   2. AB 1918 (Petrie-Norris), Chapter 561, Statutes of 2022, establishes the California Reproductive Health Service Corps program within HCAI to reduce the debt burden of current and future health care professionals dedicated to providing reproductive health care in underserved areas of California.
   3. AB 2091 (Mia Bonta), Chapter 628, Statutes of 2022, prohibits compelling a person to identify or provide information that would identify an individual who has sought or obtained an abortion in a state, county, city, or other local criminal, administrative, legislative, or other proceeding.
   4. AB 2134 (Akilah Weber), Chapter 562, Statutes of 2022, establishes the California Reproductive Health Equity Program within HCAI to ensure abortion and contraception services are affordable for and accessible to all patients and to provide financial support for safety net providers of these services.
   5. AB 2223 (Wicks), Chapter 629, Statutes of 2022, prohibits a person from being subject to civil or criminal liability, or otherwise deprived of their rights, based on their actions or omissions with respect to their pregnancy or actual, potential, or alleged pregnancy outcome or based solely on their actions to aid or assist a pregnant person who is exercising their reproductive rights.
   6. SCA 10 (Atkins) Chapter 97, Statutes of 2022, enacts a constitutional amendment, expressly providing that the state shall not deny or interfere with an individual's reproductive freedom in their most intimate decisions, which includes their fundamental right to choose to have an abortion and their fundamental right to choose or refuse contraceptives.
   7. SB 1301 (Kuehl), Chapter 385, Statutes of 2002, enacts the Reproductive Privacy Act, which provides that every individual possesses a fundamental right of privacy with respect to reproductive decisions, including the fundamental right to choose or refuse birth control, and the fundamental right to choose to bear a child or obtain an abortion.
4. TECHNICAL AMENDMENTS. The Committee may wish to make technical amendments to this bill to clarify that “participating” EDs means EDs that are participating in the RHEPP.

REGISTERED SUPPORT / OPPOSITION:

Support

Access Bridge (cosponsor)

We are Reproductive Freedom for All CA (cosponsor)
Training in Early Abortion for Comprehensive Health Care (cosponsor)

Unite For Reproductive and Gender Equity (URGE) (cosponsor)
VALOR (cosponsor)
All Above All
American College of Obstetricians & Gynecologists - District IX
Asian Americans Advancing Justice-southern California
Black Women for Wellness Action Project
California Latinas for Reproductive Justice
California Women's Law Center
Citizens for Choice
Essential Access Health
If/when/how: Lawyering for Reproductive Justice
Initiate Justice
Planned Parenthood Affiliates of California
Public Health Institute/access Bridge
Reproductive Freedom for All California
SF Black & Jewish Unity Coalition
Voices for Progress

Opposition

California Catholic Conference

Two individuals

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097