Physicians must provide abortions in medical emergencies under federal law and will face penalties if they decline to offer the procedure in these cases, Health and Human Services Secretary Xavier Becerra wrote in a letter to health care providers on Monday.

Becerra said federal law pre-empts state abortion bans in cases where women face medical emergencies associated with pregnancy under the Emergency Medical Treatment and Active Labor Act. If an abortion is necessary to treat a woman facing a medical emergency, physicians must offer the procedure, the health secretary wrote.

Hospitals that decline to provide abortions in these cases could have their Medicare provider agreement terminated or face financial penalties, Becerra said. Individual physicians could also be cut from Medicare and state health programs if they refuse to offer abortions in medical emergencies, he added. Physicians can also use federal law as a defense if they face state prosecution when providing abortions in emergencies, according to HHS.

Becerra said such medical emergencies include but are not limited to ectopic pregnancies, complications from miscarriages and hypertensive disorders such as preeclampsia that usually occurs after 20 weeks of pregnancy. Preeclampsia results in high blood pressure, severe headaches and blurred vision. The condition can lead to fatal complications if untreated.

“Under the law, no matter where you live, women have the right to emergency care — including abortion care,” Becerra said. “We are reinforcing that we expect providers to continue offering these services, and that federal law preempts state abortion bans when needed for emergency care.”