HELENA — This week, state regulators will hold a hearing on a proposed rule change that would add more requirements in order for an abortion to be covered by Medicaid.
The Montana Department of Public Health and Human Services announced the proposal, which would require prior authorization before Medicaid pays for abortion services. DPHHS leaders said additional documentation is needed to ensure that the state Medicaid program is only covering abortions that are medically necessary. However, some advocates say the change would be an unnecessary barrier to accessing an abortion.
The federal government’s Hyde Amendment prohibits Medicaid funding for abortions, except in cases of rape and incest and when the mother’s life is endangered. Montana, though, has a different standard. After a 1995 court ruling, the state has used its own general funds to cover abortions that have been determined to be “medically necessary,” even if the mother’s life isn’t endangered.
DPHHS leaders say, after a contractor reviewed Medicaid-reimbursed abortions, they concluded most claims lacked sufficient documentation to confirm medical necessity.
“The consistent lack of documentation, coupled with the conditions routinely provided on the MA-037 forms as the basis for medical necessity, lead the department to reasonably believe that the Medicaid program is paying for abortions that are not actually medically necessary, but are, in fact, elective, nontherapeutic abortions,” the rule proposal said.
The proposal would require a claim for Medicaid reimbursement to include a number of supporting documents, including a medical history, the results of a physical exam, and confirmation of a medical professional’s diagnosis. It would also say Medicaid reimbursement can only be made when a physician performs an abortion — not a physician assistant or advanced practice registered nurse.
In a statement to MTN, DPHHS director Charlie Brereton again argued the change was necessary.
“DPHHS must ensure that abortions paid for by Montana taxpayers under Medicaid are truly medically necessary, in accordance with the law,” he said. “We welcome comment on the proposed rule and look forward to further protecting the integrity of our Medicaid program through its finalization and implementation.”
But opponents of the change are expressing concerns about the impact it would have on those seeking an abortion.
“It’s functionally an abortion ban for low-income families,” said Aileen Gleizer, a communications consultant with Blue Mountain Clinic. “If individuals have private health insurance, they don’t have to go through these hoops.”
Gleizer says about half of the clinic’s abortion patients are covered by Medicaid, and that other clinics have seen similar numbers.
“Abortions are a time-sensitive service, so the mandatory prior authorization is particularly harmful,” she said. “It would delay abortions later in pregnancy, it would make them more expensive, more invasive, require a longer recovery.”
Gleizer also serves as a board member for the Susan Wicklund Fund, which provides financial support for people seeking an abortion. She said, since the vast majority of Montana counties do not have abortion providers, many of the patients they work with are traveling hundreds of miles. She said the additional requirements – especially the need for a physical exam, which she said could prevent approval by telemedicine – would hit those patients especially hard.
“Adding additional preauthorization, additional appointments, would delay,” said Gleizer. “And we don’t know what that process looks like, and what rejection looks like.”
DPHHS will hold a public hearing on this rule change Thursday, January 12, at 1 p.m., via remote conferencing. The department will accept public comment through January 20.
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