Commissioner defends Alaska’s decision regarding payment for ‘medically necessary’ abortions


Alaska’s Commissioner of Health and Social Services defended the state’s new regulation that requires abortion practitioners to explain why they thought an abortion was “medically necessary” before they receive compensation for the procedure from Alaska’s public funds.

As in other states, Alaska is subject to the long-standing federal law — the Hyde Amendment — which stipulates that federal dollars can only fund abortions in cases of rape, incest or to preserve the mother’s life. But if none of those conditions apply abortion practitioners in Alaska have been able to simply claim that an abortion was “medically necessary” and general funds from the state would then pay for abortions of low-income women on Medicaid. The new regulation, however, requested by health commissioner Bill Streur and certified by Lt. Gov. Mead Treadwell on Jan. 3, will require abortion practitioners to cite specific reasons as to why they think the abortion was “medically necessary.” The regulation takes effect Feb. 2.


The Alaska Supreme Court issued a ruling in 2001 that required the state to pay for “medically necessary” abortions, when the procedure did not qualify for federal reimbursement under the Hyde Amendment stipulation which only allows federal funds to pay for abortions in cases of rape, incest or to preserve the mother’s life.

According to Streur Alaska pays for roughly 700 abortions a year through the state’s Medicaid program for low income women with abortion practitioners simply checking a box marked “medically necessary,” but with no explanation as to why. The result is that no federal dollars have paid for Alaska abortions over the past three years. Instead, the state was required to pay the bill.

According to Streur, the cost to Alaska has been about $450 per abortion, which works out to $315,000 annually.

“The last three years, out of an average of roughly 700 abortions a year, every one of those was the second box,” Streur said. “There was none for rape. There was none for incest and there was none for physical injury, physical illness or life-dangering physical condition caused by or arising out of the pregnancy itself.”

He said it was unclear why the abortions were being performed and whether they even qualified for state payment under medical necessity.

The list of “medically necessary” reasons listed on the newly approved form come from consultation with physicians from other states who have designed similar regulations, Streur said. He added that there was also legal involvement to ensure that the regulation was constitutional.

“The main intent of this whole thing is to try and identify what kinds of medically necessary issues were involved in the decision of the physician to perform the abortion and to claim it under Medicaid,” Streur said.


Abortion rights activists and the Alaska Democratic Party issued a flurry of statements criticizing the administration of Gov. Sean Parnell for enacting the new regulation.

Planned Parenthood, the largest provider of abortions in the country, said Jan. 8 that the new regulation “is so restrictive that it’s essentially a nearly complete ban on Medicaid funding of abortion for low income women.”

Streur said such claims are “sensationalism.”

“All were saying to the physician performing the abortion is tell us what the medical necessity was,” he said. “If Planned Parenthood decides to perform the abortion and it’s not medically necessary — in other words elective — they don’t get paid (from state funds). We’re not saying we’re not going to pay for abortions. We are going to pay for medically necessary abortions and we need a little more information to understand the medical necessity.”

In a Jan. 7 statement the Alaska Democratic Party called the regulation “an unprecedented intrusion into Alaskans’ medical privacy. Mike Wenstrup, Chair of the Alaska Democratic Party, added, ”This assault on women’s rights is an affront to our Constitutional protection of privacy.”

But Streur disagreed, saying that Alaska has a right to require a definition for a medical procedure for which it is mandated to pay.

Charges that the regulation is a “bureaucratic intrusion into women’s health decisions,” came from the House Democratic Caucus on Jan. 7 via a press release by caucus press secretary Mark Gnadt. He noted that Representatives Geran Tarr, Beth Kerttula, Harriet Drummond and Senator Berta Gardner spoke out against the changes for “allowing government bureaucrats to determine which circumstances determine whether a woman’s abortion procedure is medically necessary, a determination previously left to health professionals.”

Streur responded that the regulations do not usurp a medical provider’s role.

“I’m not asking a doctor to follow my rule of what determines medical necessity. I’m asking them to explain how the abortion is medically necessary,” he said. “I can ask that for any medical procedure that we do under Medicaid.”

“We turn down [payment] for hospital stays when they keep somebody in a hospital because they don’t have anyplace to send them. We quit paying after a while,” Streur added. “It’s not extraordinary.”


With passage of the new regulation, abortion practitioners must submit a form that indicates one of 21 conditions defining what “medically necessary” means for each particular abortion they perform. The form must then be signed, dated and a copy submitted to the state Division of Health Care Services, while the original is kept on file for the patient with all supporting documentation.

To receive reimbursement from the state, abortion practitioners must affirm that the abortion was “to avoid a threat of serious risk to the physical health of the woman from continuation of her pregnancy due to the impairment of a major bodily function.” The new regulation also permits the state to fund abortions that are performed to avoid “another physical disorder, physical injury, physical illness, including a physical condition arising from the pregnancy, or a psychiatric disorder that places the woman in imminent danger of medical impairment of a major bodily function.”

Despite the fact that the “psychiatric disorder” reason may be open to abuse, Streur said he believes it should be included.

Streur admitted, however, that there was nothing to prevent abortion providers from merely claiming that the abortion was needed to avoid depression because it could lead to behavior which may put a person in “imminent danger of medical impairment or a major bodily function.”

“There nothing to stop them from checking that, but if we see a lot of those boxes checked, I will probably end up sending nurses in to do a medical chart review,” he said. The review would be to determine what indications the doctor saw for claiming the abortion as “medically necessary.”

“I can also take a look in the Medicaid payment schedule,” he said. “Have we paid for depression drugs? Have we paid for oxycodones? What have we paid for?”


'Commissioner defends Alaska’s decision regarding payment for ‘medically necessary’ abortions'
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