HYANNIS — A proposed $137-million expansion of Cape Cod Hospital could potentially be held up or denied by the Mass. Dept. of Public Health (DPH) because the hospital’s parent organization, Cape Cod Healthcare, restricts access to abortion. The plan was posted on a state website earlier this month and reported by the Boston Business Journal.

The DPH is required to review all such plans and make a “determination of need.” The law under which DPH approves or denies expansion plans explicitly cites access and quality of care, and it invites community comment. It’s not clear, however, whether the DPH could literally condition approval of the hospital expansion on the provision of abortion services. DPH’s style seems to be to cajole rather than to issue orders.

As the Independent reported last week, the two major providers of medical care on the Lower and Outer Cape — Cape Cod Healthcare (CCHC) and Outer Cape Health Services (OCHS) — both refuse to offer most abortion services. CCHC, which runs both Cape Cod Hospital and Falmouth Hospital, provides abortions only in urgent situations. OCHS says that it cannot provide abortions because it is a federally qualified health center restricted by the Hyde Amendment.

(In a letter to the editor in this issue of the Independent, Dr. Ronald Gabel of Yarmouth Port, the former medical director of a surgery center that provided abortion services, argues that OCHS is not in fact prevented from providing abortion care by the Hyde Amendment, provided that federal funds are not used to pay for it.)

A third nonprofit medical group, Health Imperatives, which operates seven clinics in Southeastern Massachusetts including one in Hyannis, has so far resisted requests to add abortion services.

Women in Massachusetts have an unrestricted legal right to abortions up to 24 gestational weeks of pregnancy — assuming that they can find a provider.

“Southeastern Massachusetts is an abortion access desert,” Dr. Jennifer Childs-Roshak told the Independent this week. She is the president and CEO of the Planned Parenthood League of Massachusetts.

“Abortion is health care,” said Childs-Roshak, “and access should not be based on one’s zip code, identity, or income level. We are committed to working with existing reproductive health-care providers on the Cape and across Southeastern Mass. to establish and expand abortion services, because everyone deserves access to care close to home.”

Planned Parenthood operates four clinics in Massachusetts, but none on the Cape.

The state has some leverage to improve access to abortion, but it’s not clear how hard the DPH is pushing, despite Gov. Charlie Baker’s stated commitment to defend and expand reproductive rights.

Last year, DPH blocked a proposed $2.25-billion expansion by Mass General Brigham to build outpatient care centers in Woburn and Westborough on the grounds that it would raise costs by substituting a teaching hospital that bills at high rates for community hospitals and clinics that bill at lower rates.

Health Imperatives, which is funded by DPH, has clinics in Hyannis, Wareham, Plymouth, Nantucket, Martha’s Vineyard, New Bedford, and Brockton. The Independent has learned that the DPH has been urging Health Imperatives to provide medication abortions. Health Imperatives’ website displays a wide range of reproductive and health services, including testing and treatment of sexually transmitted infections, birth control, pregnancy testing, cancer screening, and “gender affirming hormone therapy for all genders” — in short, everything except abortion.

In spite of the discussions with DPH, Health Imperatives CEO Julia Kehoe says that will not change.

“Currently, Health Imperatives has no plans to provide abortion-related services to our clients,” Kehoe wrote in an email to the Independent. “Since the overturning of Roe v. Wade, we have had several discussions in our community and with advocacy groups about the lack of direct abortion-related services in the area and while it is concerning, we must allocate our limited resources where they are needed most.”

A DPH spokesperson was unwilling to say that the department would insist on abortion services. “All DPH-funded sexual and reproductive health programs are encouraged, but not required, to provide abortion services as a part of full spectrum of reproductive health care,” the spokesperson said by email. But there is high interest on Beacon Hill in protecting and expanding abortion rights, and pressures on both community facilities and state agencies like DPH are likely to intensify.

Massachusetts is one of 16 states whose Medicaid program (MassHealth) fully covers abortion services. This is permitted, even though Medicaid is a state-federal program, as long as the abortion services are paid with state funds. Advocates want the Biden administration to change the rules so that federally qualified health centers like OCHS can provide abortions services.

President Biden issued a general executive order on July 7 to defend abortion rights. He gave the Dept. of Health and Human Services 30 days to write specific rules.

Editor’s note: An earlier version of this article, published in print on July 21, incorrectly stated that Dr. Gabel was the director of a women’s health clinic. He was the medical director of an ambulatory surgery center that provided abortion services.