Pennsylvania’s highest court on Monday recognized for the first time that access to abortion is a right guaranteed by the state’s constitution, a significant finding in the wake of the 2022 U.S. Supreme Court decision overturning nationwide abortion rights.

The finding came in a case focused on a much narrower issue — whether Medicaid should cover the cost of abortions in the state. But the justices, in deciding to overturn a lower court decision on that question, concluded for the first time that the state constitution’s Equal Rights Amendment — for which there is no equivalent in the U.S. Constitution — protected citizens’ rights to make their own reproductive choices.

“The fundamental right of a woman to decide whether to give birth is not subordinate to policy considerations favored by transient legislatures,” Justice Christine L. Donohue wrote for the majority in her 219-page opinion. “We conclude that the Pennsylvania Constitution secures the fundamental right to reproductive autonomy, which includes a right to decide whether to have an abortion or carry a pregnancy to term.”

The decision comes nearly two years after the U.S. Supreme Court overturned Roe v. Wade — the 1973 court decision that for decades had protected abortion access at a national level — in a ruling that held the U.S. Constitution did not confer such rights and that individual states could make their own laws governing abortion access.

Pennsylvania law currently allows abortion through the 23rd week of pregnancy.