Medicaid providers, former patients and other opponents presented a flurry of testimonies Thursday against Proposed rule change for the state health department It would add requirements for abortion to be covered by Medicaid, including providing a patient with medical information to prove that the procedure is medically necessary.
It was an administrative rule change notice First published in late December, the day before Christmas Eve. The proposal is the Department of Public Health and Human Services’ response to a study Republican lawmakers requested it in 2021 How Medicaid money is being spent on abortions. While Federal law Medicaid is prohibited for most abortions outside of rape, incest, or medical risk to the mother’s life, and a state court decided in 1995 that Montana’s medical dollars should cover abortions if they are deemed “medically necessary.”
More than two dozen people spoke out against the motion during Thursday’s virtual hearing, with at least 90 on the call. The only supporter was Derek Oestricher, principal advisor to the conservative policy group The Montana Family Foundation, who said the organization supports changing the process to ensure that taxpayer money does not cover “elective, non-curative procedures.”
Doctors, nurses and patients with personal miscarriage stories urged the administration to reject its own proposal, saying the rule unfairly targets and delays care for some of Montana’s most financially vulnerable patients and interferes with the patient-provider relationship.
“When medically necessary abortions are restricted, women’s health suffers,” said Leah Miller, MD, a Missoula physician who represents the American College of Obstetricians and Gynecologists. “Restrictions disrupt the patient-provider relationship and disproportionately affect low-income women and women who live long distances from providers.”
Sometimes doctors and former patients have cried publicly while testifying, explaining how personal and time-sensitive abortions can be. One dissident, Lorrie Morgan, recounted an abortion she had as an undergraduate in 2002 when she was on Medicaid. Morgan said her baby died after complications during a prenatal medical procedure, though she didn’t realize it until her doctor gave the news during a later appointment.
“It was a very sad, traumatic time. And I think any barrier for women, between women and their doctors during this time, is immoral,” Morgan said. Women and their doctors should be the only ones making these decisions. And we need to make these decisions on Immediately.”
Currently, providers provide a form stating that the abortion was medically necessary but are not required to provide additional information. If approved, Gianforte’s management rule change would require providers to obtain a pre-authorization for Medicaid coverage and provide supporting medical records, such as the patient’s age, medications, number of times the patient has been pregnant, number of deliveries, last menstrual period, condition and outcomes Any pregnancy test, allergies, chronic diseases, surgeries, behavioral health problems, smoking, drug use, and obstetric history.”
Other providers, including maternal-fetal medicine specialists and representatives of abortion clinics, have said the proposed operation is unnecessary and could pose risks to patients who need appropriate medical care. Dr. Timothy Mitchell, a Missoula physician, testified that termination of pregnancy even due to severe fetal abnormalities may not be considered medically necessary by department standards.
“Instead, these patients will be forced to carry these pregnancies to full term, increasing their risk of complications and prolonging their grief and recovery,” Mitchell said. Policies regulating medical care must be based on scientific evidence and best practices and maintain the doctor-patient relationship. Unfortunately, these proposed changes to Medicaid threaten physician-patient communication and undermine the physician’s medical judgment.”
The rule change would also prevent nurse practitioners and physician assistants from paying Medicaid bills for abortions, despite the fact that these professions and doctors can all legally practice abortion services in Montana. The ruling is just one part of a rule that the civil rights group considers unconstitutional and contradictory to a state court ruling in 1995, said Akila Dernos, an attorney for the Montana ACLU.
“That court held that a state cannot through administrative regulations create a public program that provides medical services to low-income Montana residents and then select abortion care for differential treatment through withholding benefits,” Dernus said. “The choice to exercise the constitutional right to abortion should not be based on income. This violates the spirit and letter of Montana’s statutory and constitutional law.”
Although the state health department did not provide a rebuttal to Thursday’s testimony, its written justification for the rule says the change will help ensure the state complies with the court’s decision on medical necessity.
Public comments may be submitted in writing to the department until 5 p.m., January 20. The administration did not say when it intends to issue its final decision on the proposed change.