Medicaid Rule Limiting Abortion Access in Montana Is Blocked After Lawsuit by the Center and Partners

A Montana administrative rule that would have effectively eliminated abortion access for most Montanans insured through Medicaid was blocked yesterday in response to a lawsuit filed April 28 by the Center for Reproductive Rights and its partners.

The temporary restraining order was issued by a Lewis and Clark County District Court judge blocking the new rule, which was to be enforced starting May 8, by the Montana Department of Public Health and Human Services. The lawsuit argues that the rule violates the Montana 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 the majority of abortion care in the large, rural state.

New Rule Would Create Numerous Barriers and Chaos for Patients and Providers 

The new rule would restrict the provision of abortion for Medicaid-eligible Montanans to physicians—eliminating access to most abortion providers in the state for people with low incomes. It would also require Medicaid members seeking abortion care to undergo an unnecessary physical exam—eliminating access to medication abortion via telehealth for Montanans on Medicaid. Those who are already strained financially would be forced to make at least one unnecessary visit to a clinic, and to miss work and make the attendant logistical arrangements for travel and childcare, which may be insurmountable.   

For those that do manage to reach a physician and make an in-person visit, the rule requires patients to obtain prior authorization and submit various documentation to the State to determine whether to approve or deny coverage for abortion care. And the new rule narrowly redefines “medically necessary” when it comes to abortion, and abortion alone. So, the State may deny Medicaid coverage for abortion care even for those who are able to overcome the various other obstacles the rule imposes. Individually and together, these aspects of the rule take away from the most vulnerable Montanans the right to make critical decisions about their health and their lives and force them to stay pregnant and give birth.

The lawsuit challenging the state rule was filed by Planned Parenthood Federation of America, the Center for Reproductive Rights, and the ACLU of Montana on behalf of All Families Healthcare, Blue Mountain Clinic, and Planned Parenthood of Montana. A hearing on the abortion providers’ request for a preliminary injunction is scheduled for May 12.

In a joint statement commenting about the temporary restraining order, the leaders from the organizations said: “We are incredibly grateful that the Court stopped this dangerous, unconstitutional new Medicaid rule from going into effect on May 8. When they rejected LR-131 last November, the people of Montana made clear that they do not want the government interfering with their reproductive health care. It shouldn’t matter what zip code you live in, how much money you make, or what insurance you use—everyone deserves access to the full range of reproductive health care services available in Montana. We will continue to fight this rule to protect pregnant Montanans with low incomes and their freedom to make decisions about their bodies, lives, and futures.”

A hearing on the abortion providers’ request for a preliminary injunction is scheduled for May 23 at 1:30 pm MT.

• Read more about the case against the Montana rule here.