Abortion rights activists aren't pleased with New York's budget that passed over the weekend — saying Wednesday the $237 billion spending plan will not assist health care providers experiencing large gaps to cover medication abortions for Medicaid patients.

Reproductive rights continue to be a national conversation after the U.S. Supreme Court heard arguments Wednesday on an Idaho abortion ban and nearly two years after the overturning of Roe v. Wade

Gov. Kathy Hochul was quick to expand access to abortion services in New York since Dobbs v. Jackson Women's Health Organization, which gave U.S. states the power to restrict abortion services or related reproductive health care. But the final budget failed to increase Medicaid reimbursement rates for health providers that offer abortion services, and advocates argue the current gap will ultimately limit access to care.

"There's a lot of work we have to do, and with the fall of Roe and the horrible stories we're hearing across the country with pregnant people not having access to the care they need," said Robin Chappelle Golston, president and CEO of Planned Parenthood Empire State Acts. "New York needs to be a lot more aggressive about meeting the needs of our residents and people who need access to care in this really difficult time."

New York's budget has $825 million for rate increases that only apply to hospitals, nursing homes and assisted living facilities. But reimbursement rates for family planning remained flat — concerning reproductive health care advocates across the state. 

Chappelle Golston said the continued disinvestment could pose challenges to providing abortion services in demand statewide.

"The math is pretty simple," she said. "Providers are losing hundreds of dollars on each patient, which leaves them in an unsustainable situation."

Providers in the state lose an average between $200 and $300 per medication abortion for Medicaid patients, Chappelle Golston said. A reimbursement rate of $550 would make providers whole, but was not included in the final budget. That gap could deepen shortages in low-income areas as more maternity wards and safety net hospitals are facing closure amid New York's elevated maternal morbidity rate.

Over 60% of Planned Parenthood patients use abortion pills, and demand could increase as the U.S. Supreme Court examines a challenge federal approval for abortion pills is challenged. 

"It really is just setting us up for failure because it's not sustainable," Chappelle Golston said. "And so the gap that we're facing financially to provide this care is really not going to work."

Last year's budget included $100 million to support abortion providers and grants through the state's Securing Reproductive Health Centers program to ensure safe access to reproductive health care.

Additionally, Hochul signed laws allowing pharmacists to distribute hormonal contraception without a prescription from a doctor, regardless of a patient's residency. The state Health Department also stockpiled 150,000 doses of the medical abortion drug misoprostol in preparation for the increased demand to send the prescription to women in states that restrict access.

"Gov. Hochul is committed to protecting reproductive freedoms in New York and has taken significant steps to expand abortion access, including investing more than $130 million for abortion providers over the past two budgets," Hochul's spokeswoman Aja Worthy-Davis said in a statement. "With women's rights under attack nationwide, Hochul will always fight to ensure New York is a safe harbor for anyone who needs abortion care."

But reproductive health advocates are celebrating other parts of the budget.

"It was a mixed bag," Chappelle Golston said of the final spending plan.

The budget included a $25 million Reproductive Freedom & Equity grant program for abortion providers to cover care for people who lack insurance and new patients.

Assemblywoman Jessica González-Rojas sponsored the bill to create the fund since Roe was overturned and said the grants should help facilities stay afloat as the battle reimbursement gaps.

"We don't want our providers and our clinics to continue to suffer that loss," Assemblywoman Jessica González-Rojas said. "This fund would help them recoup some of that money." 

NOW-NYC President Sonia Ossorio said she's confident the investments from the last two years has prepared the state to ensure abortion care and reproductive health for any person who needs it.

"There is an incredible community of new Yorkers who are ready to fill that gap," Ossorio said. "The issue of Medicaid is very complex and it’s not something that any one elected official can wave a wand and fix. What I do know is, not a day has gone by where Hochul has not pushed and fought to increase those rates, to get money to clinics to build infrastructure to stockpile medication abortion and to make sure that doctors here who do telemedicine for women in other states ... are protected legally."

It's unclear how the demand for abortion services in New York have increased since Roe was overturned. State Department of Health data lags a few years, and the most recent data available about women who received abortion services in the state is from 2021, or before the landmark decision.

Republican lawmakers and organizations like the state Right to Life Committee continues to push back on expanded abortion access for out-of-staters and using public tax dollars to support reproductive health providers.

"We know that there are better answers to problems than killing a child," Right to Life Committee spokeswoman Lori Kehoe said in a statement. "If the state of New York would dedicate more resources to helping moms and families in crisis and stop pushing killing as an answer, our whole state would be healthier and certainly more whole."

New Yorkers in November will vote on a constitutional amendment to enshrine the right to an abortion in the state Constitution.