A trial is underway in Alaska to determine if administrative attempts to drastically cut off abortion access for low-income people in the state violates the Alaska Constitution.

At issue is a 2013 regulation that advocates claim seeks to circumvent a 2001 decision by the Alaska Supreme Court ordering the state Medicaid program to cover all abortions determined by a physician to be medically necessary. That decision said the state’s Medicaid program must cover “those abortions … necessary … to ameliorate a condition harmful to the women’s physical or psychological health, as determined by the treating physician performing the abortions services in his or her professional judgment.”

But under the 2013 regulation at issue in Planned Parenthood’s lawsuit, for an abortion to be covered by Medicaid the physician performing the procedure must certify that an abortion is “medically necessary to avoid a threat of serious risk to the physical health of the woman from continuation of her pregnancy due to the impairment of a major bodily function.”

The physician must then check a box to explain the condition the woman has that meets this standard by choosing from a list of 21 identified conditions, or indicating that she either has “another physical disorder, physical injury, physical illness, including a physical condition arising from the pregnancy” or “a psychiatric disorder that places the woman in imminent danger of medical impairment of a major bodily function if an abortion is not performed.”

Even if a patient qualifies under the 2013 definition of “medically necessary,” Medicaid is not guaranteed to cover the procedure.

Even with one of those identified conditions, Medicaid will only cover the cost of an abortion if a doctor attests that the abortion is “medically necessary to avoid a threat of serious risk to the physical health of the woman from continuation of her pregnancy due to the impairment of a major bodily function.”

No other provider in Alaska is required to submit a similar certificate.

Advocates argued in a lawsuit filed in January 2014 on behalf of Planned Parenthood of the Great Northwest that this new rule unconstitutionally precludes all but the most severely ill women from qualifying for coverage they are otherwise guaranteed.

Judge John Suddock in February 2014 blocked the regulation from taking effect and ordered a trial on Planned Parenthood’s claims.

Suddock is overseeing the trial, which is expected to last until next week.