Lawmakers narrowly shot down an amendment Thursday that would have created a panel to review abortions for women who are insured through Medicaid.
On the same bill, GOP lawmakers were successful in an amendment clarifying the state health department could end continuous eligibility for the state's Medicaid expansion program.
The abortion panel proposal came in an amendment proposed for House Bill 686 that implements parts of the state Department of Public Health and Human Services' budget. The vote was 9-10, with a handful of Republicans joining all Democrats in opposition.
The amendment would have created a panel of three physicians, with the governor, Senate president and House speaker each appointing one, to determine if abortions for women insured by Medicaid were reimbursable. To qualify, the abortion would have to be deemed medically necessary, necessary to save the life of the mother or because the pregnancy resulted from rape or incest.
Sen. Janet Ellis, a Democrat from Helena, said the federal Hyde Amendment already accomplished what the amendment proposed.
The Hyde Amendment, passed in 1976, stops Medicaid funding from paying for abortion care. There are exceptions for when a woman's life is at risk or when the pregnancy is from rape or incest. Information from the Kaiser Family Foundation, however, shows Montana is one 15 states that used state money to in part supplement what the federal funding won't cover.
Sen. Jeffrey Welborn, R-Dillon, was one of the Republicans who voted against the panel proposal.
"Whether we agree with this procedure or not, it's still a legal procedure and what we're seeking to do here is set up basically a court to decide the legitimacy of whether somebody's been raped or abused," Welborn said. " ... This is not getting government out of our lives. It's pushing our own brand of government on people's lives and I certainly can't support it."
Sen. Carl Glimm, R-Kila, defending the amendment, saying that it was "worth having another set of eyes" to review decisions.
"That's what we want, another set of eyes to look at, just to check to make sure they're medically necessary," Glimm said.
Three bills to limit access to abortions have cleared the Legislature. That includes a bill banning abortions after 20 weeks gestational age; that legislation has been endorsed by Republican Gov. Greg Gianforte. The other two would require informed consent before a medical abortion and require the opportunity to view an ultrasound before an abortion. Two versions of a so-called "pain-capable" act are also advancing.
A successful amendment to the bill Thursday gives the state Department of Public Health and Human Services the ability to end the state Medicaid expansion program's continuous eligibility.
Continuous eligibility means people who are qualified for the program remain qualified for a year. It was put into place to prevent what's called churn, or when people move from being qualified to not and then back to qualified. That happens because of fluctuation in pay from things like overtime hours or seasonal work or change in household composition from moving.
Because the federal government assumes some cost savings from not more frequently checking eligibility and not having that churn, it gives states with continuous eligibility a lower federal match, paying 89% of the program costs instead of 90%.
The state budget already accounts for dropping continuous eligibility, which Glimm said is a $7 million savings. A previous bill aimed at ending the provision and increasing the ways qualifications were checked died in a House committee.
Ellis objected to the amendment, saying it tied the hands of the health department and that not frequently checking eligibility saves the state work and money.
While Glimm told Ellis and the committee the new director of the state health department already ended continuous eligibility, a spokesperson for the department said Thursday that wasn't the case — though it is the intent.
"At the conclusion of the active public health emergency, Montana DPHHS desires to discontinue the 12-month continuous eligibility process for MAGI (modified adjusted gross income) adults in its Medicaid program," wrote spokesperson Jon Ebelt. "The Legislature has also reduced related funding in (the state budget bill)."
Ebelt said there's not a statutory requirement to provide continuous eligibility and that the change could be made under administrative rule.
The state included continuous eligibility in its waiver application to run its Medicaid expansion program. Ebelt said the health department has contacted the federal Centers for Medicare and Medicaid "for guidance on the process to make the change once the public health emergency has concluded."
The federal government has maintenance of eligibility provision in place during the pandemic to prevent people from losing coverage, and that includes prohibiting states from changing eligibility criteria during the state of emergency.