Montana health officials weigh new regulations for Medicaid abortion coverage
Abigail Adcox
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Montana health officials are considering requiring prior authorization before the state’s health department pays for abortions for Medicaid patients.
The proposed rule by the state’s Department of Public Health and Human Services would require doctors to provide medical documentation that shows an abortion is necessary to save a patient’s life or “medically necessary” for another reason before Medicaid would agree to cover the procedure.
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Health providers would be required to provide records supplying patient information such as age, smoking, behavioral health issues, and illegal substance history.
Prior authorization would not be required for incomplete abortions, septic abortions, or miscarriages under the proposal. Currently, doctors are not required to provide documentation for Medicaid coverage of an abortion deemed medically necessary.
The state health department said the proposal would write into state codes a 1995 court decision that determined Montana’s state Medicaid funds must cover abortions if they are medically necessary.
After a review of abortions paid for by state Medicaid dollars over the past decade, the department said in an explanation of the proposed rule that it had reason to believe “the Medicaid program is paying for abortions that are not actually medically necessary, but are, in fact, elective, nontherapeutic abortions.”
It would define a medically necessary abortion as one that is performed to protect the mother’s life or to prevent “significantly” aggravating a physical or psychological condition that the patient has been previously diagnosed with. The proposed rule would also require that physicians provide abortions, leaving out physician assistants or advanced practice nurses.
Montana is one of 16 states where Medicaid is required to pay for all or most “medically necessary” abortions, according to the Guttmacher Institute. The federal Hyde Amendment restricts state Medicaid programs from using federal funds to cover abortions except in cases of rape, incest, or life endangerment.
The proposal has gotten blowback from opponents who argue it would delay or deny abortions for low-income women in the state. Over 20 opponents, including doctors, patients, and advocacy groups, voiced their concerns about the proposal in an online hearing on Thursday, suggesting prior authorization would pose risks to patients who need expedited care.
“When restrictions are placed on medically necessary abortion, women’s health suffers,” said Leah Miller, a physician representing the American College of Obstetrics and Gynecology, per the Montana Free Press. “Restrictions disrupt the patient-provider relationship and disproportionately affect low-income women and women who live [a] long distance from providers.”
Montana’s health department has not announced when it will issue its final decision about the proposed rule.
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As of 2019, seven states required prior authorization for Medicaid coverage of an abortion, according to a federal report.
Abortions are currently legal in Montana until fetal viability, which is typically around 24 to 26 weeks of pregnancy, as a 2021 law that would have prohibited abortions after 20 weeks remains blocked in the court system.