A Montana District Court judge has struck down two laws that sought to impose severe restrictions on abortion access for Medicaid recipients, ruling that they violated the state constitution. The decision reinforces Montana’s long-standing legal protections for reproductive rights and prevents what advocates called unnecessary and discriminatory barriers to abortion care.
Judge Mike Menahan of the Lewis and Clark County District Court ruled that House Bill 544 and House Bill 862, both passed by the Republican-controlled Montana Legislature in 2023, violated the constitutional rights of women by imposing undue burdens on those seeking abortions through Medicaid-funded healthcare services. The laws were nearly immediately halted after being signed by Governor Greg Gianforte and have now been permanently struck down.
Menahan’s decision leans on Montana’s robust legal precedent protecting abortion rights, including a 1999 state Supreme Court ruling that affirmed a constitutional right to abortion prior to fetal viability. Montana voters also passed a state constitutional amendment in 2024, explicitly enshrining abortion rights in state law.
The ruling not only blocks the onerous restrictions these laws sought to impose but also sets a legal precedent ensuring that low-income women on Medicaid are not treated differently from other patients seeking reproductive healthcare.
“The relevant inquiry is not whether the right of privacy requires the state to fund abortions, but whether, having elected to participate in a medical assistance program, the state may selectively exclude from such benefits otherwise eligible persons solely because they constitutionally protected healthcare decisions with which the state disagrees,” Menahan wrote.
What the struck-down laws would have done
House Bill 544
• Required prior authorization for abortion care.
• Allowed only physicians to perform abortions, eliminating access to care from advanced practice clinicians like nurse practitioners and physician assistants.
• Mandated additional physical examinations and excessive documentation, delaying access to care.
House Bill 862
• Prohibited public funds, including Medicaid, from covering abortion services except in cases of rape, incest, or life-threatening conditions for the pregnant person.
• Created a double standard where Medicaid would cover pregnancy-related costs for those who carried to term but denied coverage for those seeking an abortion.
Montana Department of Public Health and Human Services (DPHHS) Rule
• Reinforced HB 544’s restrictions, preventing telehealth medication abortions.
• Required additional state-mandated justifications before an abortion could be approved under Medicaid, including intrusive questions about a woman’s reproductive history.
Montana’s Supreme Court previously ruled that abortion is a fundamental right under the state constitution’s right to privacy. Judge Menahan reaffirmed that Medicaid recipients seeking abortions cannot be treated differently from other patients receiving state-funded medical care.
“The state admits it has no evidence that medication abortions provided via telehealth are any less safe or effective than abortions provided in-person,” Menahan wrote.
The court ruled that the state failed to demonstrate any legitimate medical justification for the restrictions.
Judge Menahan also found that the laws created an unfair and unconstitutional distinction between Medicaid recipients who sought abortions and those who carried pregnancies to term.
“Pregnant women who seek to terminate their pregnancy are subject to one definition of medical necessity while pregnant women who seek to carry their pregnancy to term are subject to another definition of medical necessity.”
The ruling relied heavily on a 1995 Montana Supreme Court decision, Jeannette R. v. Ellery, which found that the state cannot selectively restrict Medicaid benefits based on political opposition to abortion.
Montana has become a battleground for abortion rights following the Supreme Court’s decision to overturn Roe v. Wade in 2022. Unlike many other Republican-led states, Montana has consistently upheld abortion access through the courts.
• In 1999, the Montana Supreme Court ruled that the state constitution guarantees abortion rights up to fetal viability.
• In 2024, Montana voters passed a state constitutional amendment explicitly protecting abortion access, despite Republican-led efforts to impose new restrictions.
• Every legislative attempt to restrict abortion in recent years has been blocked by the courts, reinforcing Montana as an outlier among red states.
Planned Parenthood of Montana, the Center for Reproductive Rights, the ACLU of Montana, Blue Mountain Clinic, and All Families Healthcare released a joint statement following the ruling:
“Every Montanan deserves the ability to access quality, timely healthcare, regardless of where they live or how much money they make. We are relieved that these dangerous restrictions have been struck down for good, and that patients will continue to have the access that these laws would have forbidden. The government has been relentless in their attempts to undermine healthcare without a thought for the consequences for patients’ health and lives. Montanans made their voices heard last year when they voted to further protect abortion rights, sending a clear message that politicians have no place in exam rooms. With this win, we will continue our fight to ensure everyone in Montana can make their own decisions about their own lives.”
Martha Fuller, president and CEO of Planned Parenthood Montana, also emphasized the importance of this victory:
“The ruling was a victory for Montanans’ reproductive rights, and it enables abortion providers in Montana to keep providing abortion care to Medicaid patients. If the State appeals the ruling, we stand ready to continue to defend the fundamental rights of Medicaid patients at the Montana Supreme Court.”
State Republican response and potential appeal
• Montana Republicans are expected to appeal the ruling to the Montana Supreme Court, where previous rulings have favored abortion rights.
• The state’s highest court has consistently ruled in favor of reproductive rights, but an appeal could delay legal certainty.
Impact on future legislative efforts
• Montana Republicans are expected to introduce new abortion restrictions in the next legislative session.
• The ruling sets a strong legal precedent, making it more difficult for lawmakers to impose similar restrictions in the future.
Montana’s role in the national abortion rights debate
• Montana remains a critical state in the national abortion rights battle, demonstrating that constitutional protections can withstand Republican legislative efforts.
• The ruling could influence court challenges in other states, reinforcing legal arguments against Medicaid abortion restrictions.
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