Ensuring Abortion Access for Montanans Using Medicaid
This case seeks to block unnecessary restrictions for Montana Medicaid patients accessing abortion care.
Case update: On March 11, 2025, a Montana district court permanently blocked these restrictions, which would have effectively eliminated abortion access for most Medicaid patients. The court agreed with arguments by the Center and its partners that the restrictions violate Montanans’ constitutional right to abortion. Read more here and below.
SummarySummary
The Center for Reproductive Rights and its partners filed a lawsuit on April 28, 2023, to challenge a new rule by Montana’s Department of Public Health and Human Services (DPHHS) that would effectively ban Medicaid members from accessing abortion care in the state.
The Center filed this lawsuit on behalf of the two independent clinics in Montana: All Families Healthcare and Blue Mountain Clinic. About half of the patients these clinics currently see for abortion care rely on Medicaid. Under the rule, all or nearly all of them will be unable to access care.
BackgroundBackground
In Montana, Medicaid is required to cover “medically necessary” care, including abortion care. If enforced, however, the new rule would only allow Medicaid-eligible Montanans to obtain abortion care from physicians, eliminating their access to care from advanced practice clinicians, physician assistants, nurse practitioners, and nurse midwives. Medicaid has long covered abortion care from a wide range of non-physician providers, who provide the majority of abortion care in the large, rural state.
In addition to limiting Medicaid patients’ options for care, the new rule would impose an unnecessary physical exam requirement on Medicaid-eligible Montanans, eliminating their access to telehealth care entirely. Medicaid patients who are already strained financially would thus be forced to make at least one unnecessary visit to a clinic, requiring many to miss work and make costly logistical arrangements for travel and childcare.
Further, the new rule would force patients to obtain prior authorization and submit various documentation to the State to determine whether Medicaid will cover their care, allowing the State to deny coverage even for patients who overcome all other barriers. Moreover, the rule restrictively redefines what Medicaid considers “medically necessary” when it comes to abortion, and abortion alone, singling out low-income Montanans seeking abortion care and their providers for differential treatment.
About the caseAbout the case
In the lawsuit, the Center and its partners argue that the new rule undermines the Montana Constitution’s explicit guarantee of privacy, as well as the Montana Administrative Procedure Act.
Specifically, the new rule:
- Contradicts the 1999 ruling by the Montana Supreme Court, which held that the state constitution’s right to privacy protects the right to access abortion from a chosen provider.
- Violates Medicaid patients’ right to informational privacy by forcing providers to divulge sensitive and unnecessary patient medical information to DPHHS.
- Violates the Montana Constitution’s equal protection guarantee.
- Discriminates against Medicaid members based on their sex, the type of care they seek, and the way they exercise their fundamental right to reproductive autonomy and to access pregnancy care.
- Violates clinicians’ own equal protection rights by discriminating against Medicaid providers who provide abortions and non-physician providers.
About the rulings
On May 1, 2023, a Lewis and Clark County District Court judge issued a temporary restraining order blocking the new rule from taking effect while litigation continues. After the state passed two restrictive Medicaid laws that month, the complaint in this case was amended on May 18 to also challenge those laws, HB 544—which is nearly identical to the administrative rule; and HB 862—which copies the federal Hyde Amendment. The Montana Supreme Court upheld the injunction on October 9, 2024, after finding that the rule likely violated Montana’s state constitution.
The District Court ruled to permanently block the restrictions on March 11, 2025.
Case detailsRelated stories
Center and Partners Sue to Protect Abortion Access for Montanans on Medicaid
Challenging Unnecessary Regulations for Abortion Clinics in Montana
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