Proposed law would create abortion review committee for Medicaid

A first-of-its-kind abortion review committee for patients who get an abortion using Medicaid funds has been proposed by Rep. Matt Regier, R-Kalsipell.

In a new amendment that was proposed after House Bill 686 cleared the state’s House of Representatives, Regier created what opponents are calling an “abortion court,” to review whether the state will pay abortions funded through Medicaid. The proposal has yet to be heard in Senate Finance and Claims.

Neither the state nor Planned Parenthood could give definite numbers about how often abortions are conducted under the plan. However, Regier’s bill would create a three-person review committee that would decide whether to pay the claims after the fact and would review the medical records of the Medicaid patients who obtained the abortion.

The bill requires that the committee must ensure that the abortion was medically necessary; necessary to save the life of the mother, or provided to terminate a pregnancy that was the result of rape or incest.

The committee would consist of three physicians — one appointed by the governor; one by the Speaker of the House; and one by the president of the Senate. All of those positions are currently held by Republicans.

The amendment to the bill, which has not been debated in the Senate, would mean the committee of three physicians would have to verify the criteria for an abortion was met before reimbursing for the procedure. It also outlines an appeals process if the woman is denied coverage.

The amendment also calls for funding and reimbursing some of the expenses of the doctors.

Calls and emails to Regier for comment on this proposed legislation went unanswered on Monday and Tuesday.

Martha Stahl, chief executive officer of Planned Parenthood Montana, said the proposal is just another hurdle placed by lawmakers to make access to healthcare harder for some women.

“First and foremost, targeting Medicaid recipients is heartless and cruel because these women cannot afford an abortion without Medicaid covering it,” Stahl said.

One of the challenges her group sees with the proposal is that Montana law and Medicaid already are obligated to cover abortions deemed medically necessary. This measure, she said, is redundant and wasteful, not to mention harmful to women.

“It puts some women in the position of not knowing whether something is going to be covered until after the fact,” she said.

She suspects that’s the point: To make abortion more difficult and cumbersome, not to root out fraud.

“Medicaid is already charged with rooting out fraud in the system,” she said.

Pregnancy is also somewhat unique as a medical condition. For example, if a patient is considering whether to have a surgical procedure and there’s a concern with insurance coverage, often there’s time to resolve it or save money for the out-of-pocket expenses. However, pregnancy is different.

“You can’t put off pregnancy. It’s imminent, and the longer you wait, the more complicated it becomes,” Stahl said.

She said the amendment, if passed, could also drive providers away from performing the procedure.

“This injects chaos into the system,” Stahl said. “Providers will not know if they are going to be second guessed. Or, they might wonder, ‘Will I be responsible for paying this?’”

The new system, she argued, could pit medical provider against a team of three physicians who may or may not have expertise in reproductive care and health.

“No other medical service is treated this way. No one else has a panel reviewing, ‘Gosh, did they need that appendectomy?’” Stahl said. “The other piece that is super problematic is that whether it’s medically necessary or not, it treats one group of women one way and the rest differently.”

For example, one group of women may not be subject to a state team of doctors reviewing their medical files, while others, on Medicaid, would be scrutinized.

The Senate has yet to schedule action on the amendment.

HB686, which did not include the abortion amendment but did contain authorization for closing the Montana Developmental Center in Boulder, passed out of the House 72-27.