Protecting Medicaid Patients: Montana Court’s Ruling Blocks Hurdles to Abortion Care

Several hurdles that would have effectively eliminated access to abortion care for most Montanans insured through Medicaid have been permanently blocked by a Montana district court.

The ruling came March 11 in a lawsuit filed in 2023 by the Center for Reproductive Rights and its partners challenging a state administrative rule and two restrictive state laws as a violation of Montana’s constitution.

In Montana, Medicaid is required to cover “medically necessary” care, including abortion care, and covers that care when it is provided by physicians as well as advanced practice clinicians—including physician assistants, nurse practitioners, and nurse midwives—who provide most of the abortion care in the large, rural state.

The restrictions that were blocked would have created new obstacles for Medicaid-eligible Montanans to access abortion care by limiting the provision of care to physicians and requiring patients to undergo an unnecessary physical exam, obtain prior authorization, and submit burdensome documentation. In addition, the rule created a narrow definition of “medically necessary” care.

The ruling also blocks a law that would have prevented Medicaid patients from having coverage of abortion care in almost all cases, except where the pregnancy is “the result of an act of rape or incest” or would place the patient “in danger of death.”

“We are relieved that these dangerous restrictions have been struck down for good, and that patients will continue to have the access that these laws would have forbidden. . . Montanans made their voices heard last year when they voted to further protect abortion rights, sending a clear message that politicians have no place in exam rooms. With this win, we will continue our fight to ensure everyone in Montana can make their own decisions about their own lives,” said a joint statement by the Center, Planned Parenthood of Montana, the ACLU of Montana, Blue Mountain Clinic, and All Families Healthcare.

Lawsuit Argues Medicaid Restrictions Violate Montana Constitution’s Rights to Privacy and Equal Protection

In challenging Montana’s Medicaid restrictions, the Center and its partners argued that they violate:

• The Montana constitution’s explicit guarantee of privacy—which the Montana Supreme Court has held protects the right to access abortion and to access abortion from a patient’s chosen provider.
• The Montana constitution’s equal protection clause by discriminating against Medicaid members who seek abortion care, as compared to members who decided to carry their pregnancies to term.
• Clinicians’ own equal protection rights by discriminating against Medicaid providers who provide abortions, as compared to providers who care for pregnant patients not seeking abortions.

The case, Planned Parenthood of Montana, et al. v. State of Montana, et al., was filed in April 2023 by the Center for Reproductive Rights, Planned Parenthood Federation of America, and the ACLU of Montana on behalf of All Families Healthcare, Blue Mountain Clinic, Planned Parenthood of Montana, and two abortion providers.

Click here for an update on recent court rulings in Center cases, including a win for abortion rights under Arizona’s state constitution and a UN ruling protecting sexual abuse survivors from forced motherhood.