New Medicaid Proposal Would Limit Abortion Access

A proposed Montana Department of Health and Human Services amendment would add barriers to abortion access for low-income Medicaid recipients – creating higher costs for the state and putting clinics at financial risk

By Maggie Dresser
Hundreds gathered for an abortion rights march in downtown Kalispell on May 14, 2022. It coincided with many protests around the country over the weekend after a leaked majority draft opinion from the U.S. Supreme Court revealed a vote to overturn Roe V. Wade. Hunter D’Antuono | Flathead Beacon

In a new proposed amendment, officials with the Montana Department of Health and Human Services (DPHHS) are hoping to add extra barriers to Medicaid-covered abortions by limiting services based on the recipient’s medical conditions, requiring time-delaying authorization and prohibiting “mid-level” abortion providers from treating patients.

According to the proposal, those seeking an abortion will only be eligible if their circumstance is “medically necessary,” which a physician must approve and ranges from life endangerment to physical and psychological conditions. 

“DPHHS must ensure that abortions paid for by Montana taxpayers under Medicaid are truly medically necessary, in accordance with the law,” DPHHS Director Charlie Brereton wrote in a statement to the Beacon. “We welcome comment on the proposed rule and look forward to further protecting the integrity of our Medicaid program through its finalization and implementation.” 

If passed, the rule would be effective on or after the date of the finalization, according to the proposal. DPHHS officials did not specify a date. 

At All Families Healthcare in Whitefish, advanced practice registered nurse (APRN) Helen Weems provides medical and surgical abortions and about 55% of her clients are Medicaid recipients. As an APRN, the proposed rule would prohibit Weems from providing abortions to Medicaid recipients, allowing her to only give care to patients who pay in full or are covered through a private insurer. 

According to the amendment proposal, DPHHS officials recognize the new rule would be more costly for the department because physician Medicaid reimbursement rates are higher than “mid-level” provider rates, which includes APRN’s and midwives. 

“All Families is staffed by me and there are no other physicians that are willing or able to step up in the Flathead,” Weems told the Beacon. “It is, in effect, a ban on abortion. It would close this clinic.”

In addition to the restriction on providers, the rule would also require “prior authorization,” creating a delay for patients who are seeking a time-sensitive procedure. 

According to the proposal, Montana legislators in 2021 directed DPHHS to review abortion claims from 2011 to 2021 and the rules and definitions of Medicaid-reimbursed abortions. The department, using the services of a contractor, concluded that the forms being used lacked “sufficient information to support medical necessity,” suggesting that additional documentation was needed. 

Officials also concluded that documentation referred to vague medical conditions of “complications of unintended pregnancy” rather than the documentation to support an “actual complication or disease.”

The state’s contractor recommended that Medicaid-funded abortion claims “should be supported by documentation” and should require a medical diagnosis or condition necessitating an abortion. Based on the contractor’s conclusion, the lack of documentation “lead the department to reasonably believe that the Medicaid program is paying for abortions that are not actually medically necessary, but are, in fact, elective, nontherapeutic abortions,” according to the proposal. 

DPHHS officials on Jan. 12 hosted a public hearing for members of the public to testify, where dozens of opponents and one proponent provided public comment. 

“Funding unnecessary medical procedures ultimately reduces funds reserved for qualifying individuals under Montana’s Medicaid program. These proposed amendments are common sense safeguards to protect the financial stability of Montana’s Medicaid program,” said Derek Oestreicher, the chief legal counsel for the Montana Family Foundation.

Several physicians, abortion providers, attorneys, Medicaid recipients and members of the public spoke in opposition of the proposal, arguing that the rules would delay patient care, create barriers for low-income people, and cause physical and psychological trauma for those seeking an abortion while costing the state more money. 

“It would bar Medicaid members from essential pregnancy care,” Weems said at the hearing. “It would force low-income pregnant people to endure a pregnancy and childbirth, which are comparatively more dangerous and costly than an abortion. To bear children that they know in their hearts that they don’t have the physical, emotional and financial capacity to raise. Not only is forced pregnancy cruel and inhume, it goes against the mandate of Montana Medicaid to provide necessary medical services to those in need. Abortion is essential and medically necessary medical care.”

Several people from across the state shared personal stories of unplanned pregnancies, explaining the negative consequences the rules would have caused if they were imposed. One person testified that she had an emergency abortion that would have otherwise been fatal due to internal bleeding. Another testified that Medicaid previously funded her abortion and told officials if she hadn’t received services, she would have used Medicaid for prenatal care, birth and therapy – bills that would have been much more expensive than an abortion. 

Others at the hearing testified that the rule would contradict Gov. Greg Gianforte’s “Red Tape Relief” effort.

“These rules are proposals that would promote unnecessary delays in healthcare for necessary procedures and it does nothing to reduce the cost of red tape – in fact – it’s a whole page of red tape,” said Glendive resident Pat Mischel.

Susan Cahill, a retired physician assistant and abortion provider in Kalispell, argued that providers document sufficient information and since abortions are time sensitive, mandatory prior authorization delays patient care, which becomes more invasive and expensive with time, she wrote in a letter to DPHHS director Charles Brereton. 

Weems told the Beacon that she and other providers will sue the state and seek an emergency injunction if the proposed rule is finalized.

In the meantime, Weems is educating her patients about the proposed amendment and if the rule is enacted, she will continue providing abortions without Medicaid reimbursement, absorbing the economic losses. 

“It will impact patients immediately and it will impact clinics and All Families’ viability will be seriously threatened,” Weems said. “We will continue providing care because it’s the right thing to do. We will continue at a loss.”

Stay Connected with the Daily Roundup.

Sign up for our newsletter and get the best of the Beacon delivered every day to your inbox.