As states seek to limit abortions, Montana wants to redefine what is medically necessary

Katheryn Houghton, Kaiser Health News on

Published in Political News

Montana’s conservative leaders, stymied by the courts from passing laws that impose significant statewide abortion restrictions, seek to tighten the state’s Medicaid rules to make it more difficult for low-income women to receive abortions.

The Montana Department of Public Health and Human Services is proposing to define when an abortion is medically necessary, limit who can perform such services, and require preauthorization for most cases.

The push to change the regulations is borne of a belief by Republican Gov. Greg Gianforte’s administration that health providers are using existing rules that allow Medicaid reimbursements to cover abortions that aren’t medically necessary.

“Taxpayers shouldn’t foot the bill for elective abortions,” said Gianforte spokesperson Brooke Stroyke.

Medical professionals have said the term “elective abortions” can misrepresent the complex reasons someone may seek an abortion and constrain health providers from making their best clinical judgment. Laurie Sobel, associate director of Women’s Health Policy at KFF, said that appears to be the aim of the Montana proposal’s focus on defining medically necessary abortions.

“It looks like Montana’s trying to curtail abortion access under Medicaid and take the conversation of ‘medically necessary’ away from a physician and a patient,” Sobel said.


Democratic lawmakers and many health providers have said existing state rules ensure providers consider and document why an abortion is needed to protect a patient.

Democratic state Rep. Ed Stafman, who recently chaired the Children, Families, Health, and Human Services Interim Committee, said the proposed changes are unnecessary because the state already complies with federal Medicaid rules on abortion.

“It’s clear that this is part of the anti-abortion agenda,” Stafman said.

States are barred from using federal funds to pay for abortions except in cases of rape or incest, or when a woman’s life is at risk. However, states have the option of using their own money to allow reimbursements under the joint state-federal Medicaid program in other circumstances.


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