The proposed change would require providers to get state approval before performing an abortion, except in emergencies, and submit supporting documents to justify the medical necessity. That preauthorization process would entail providing state officials details of patients’ medical history, such as how many pregnancies a person has had, the date of their last menstrual cycle, whether they smoke, the results of any pregnancy tests, and whether they have ever had behavioral health issues or substance use disorders.

Martha Fuller, president and CEO of Planned Parenthood of Montana, said providers already collect that information but don’t send it to the state. If they are required to do so, she said, that will have a chilling effect that may keep people from seeking help or lead them to pay for it out-of-pocket, if they can.

“Patients could feel like, ‘Oh, and everything that I tell you, it’s going to be now shared with my insurer for the purpose of them making a decision about whether or not I can have an abortion?’” Fuller said.

In Montana, a patient seeking an abortion via medication typically gets that through nurse practitioners or physician assistants instead of going through one of the few physicians who provide that care through Medicaid, Fuller said. She said Medicaid patients would see longer wait times if the new rules are put in place as they wait to see a physician. And waiting for prior authorization would add to the time in limbo.

Telehealth helps provide access amid scattered resources across the big, rural state, but Montana’s proposed changes would require a physical examination.

“Patients might have to make a more invasive procedure. They may have to travel. They have to take more time off from work,” Fuller said. “There will be patients who will decide not to seek abortion care because they cannot afford it.”

Of the 1,418 abortions covered by Montana Medicaid in 2020 and 2021, state records show, one was performed because a person’s life was in danger. The rest were performed under the broader medically necessary justification, with paperwork about those cases including a brief explanation for why the procedure was needed.

According to the state’s proposed rules, the lack of supporting documentation for the procedures leads “the department to reasonably believe that the Medicaid program is paying for abortions that are not actually medically necessary.”

In 2021, state lawmakers passed and Gianforte signed three laws restricting abortions that a court temporarily blocked. The Montana Supreme Court upheld the injunction, arguing that the state constitution’s right-to-privacy provision extends to abortion.

Gianforte and the state attorney general have called on the Montana Supreme Court to strike down the two-decade-old ruling that tied abortion to the right to privacy. Republican lawmakers also have filed a slew of abortion-related bills in the legislative session, including one proposal to exclude abortion from the state’s right-to-privacy protections.

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(KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.)

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