Montana requires prior approval for Medicaid-paid abortions

HELENA (AP) — Montana physicians will have to provide prior documentation showing that an abortion is medically necessary before the state's Medicaid program will authorize payment for the procedure, under a new rule that takes effect next week.

The required information includes the number of pregnancies and children the woman has, the results results of a physical exam, pregnancy test, gestational estimate as well as documentation of the reason for the procedure and a signed consent form.

Montana's Legislature also passed a bill this week to put similar requirements into state law starting on July 1. That measure will go to Republican Gov. Greg Gianforte for his signature.

The Department of Public Health and Human Services took public comment about the proposed rule change to require prior authorization in January, with opponents saying it could reduce access, delay and possibly prevent abortion care for low-income women. Some opponents argued it would violate their privacy by requiring personal information to be sent to the company holding the prior authorization contract.

The health department said a review of abortions over the past decade led it to believe it was paying for elective abortions because the agency did not receive enough documentation from providers to prove the procedures were medically necessary.

Medicaid regulations say federal money can only be used for abortion care in cases of rape, incest or a threat to the life of the mother. But under a 1995 court ruling, Montana Medicaid must also cover the cost of abortions that are considered medically necessary.

The legislation, which takes effect Monday, says abortions are considered medically necessary if the woman suffers from a physical condition or a severe mental illness or intellectual disability that would be significantly aggravated by the pregnancy.

Under the rules, the prior authorization process must take place within three working days.

Montana Medicaid will only cover abortions provided by physicians — the rule and the legislation state — to meet federal Medicaid guidelines.

Physician assistants can legally provide abortion care in Montana and the Montana Supreme Court heard arguments in December over whether nurse practitioners can provide abortion care if they are properly trained. One nurse practitioner in Montana has been allowed to perform abortions since 2018 under a ruling in that case.

"At Planned Parenthood of Montana, we have nurse practitioners and/or physician assistants in every single health center every day," Martha Fuller, president and CEO of Planned Parenthood of Montana said in January. "We don't have physicians in every health center every day. It really would impact access."

Planned Parenthood has clinics in Billings, Great Falls and Helena. Other providers have in-person clinics in Missoula and Whitefish.

The health department argued a physical exam and documentation ensures the safety of the patient, can rule out ectopic pregnancy and ensure the gestational age is within Food and Drug Administration guidelines for the type of abortion being performed.

The state does acknowledge that in the case of rare, severe fetal abnormalities that would be incompatible with life upon delivery, the situation may not meet the definition of medical necessity and that Medicaid wouldn't provide coverage.