Bridgercare, TItle X Funding, Hospital File

Registered Nurse Catherine Akin poses for a photo with Development Coordinator Emily Allison on Wednesday, Sept. 19, 2018, at Bridgercare.

Montana’s largest sexual health care provider is breaking from a federal family planning program rather than agree to stop referring women for abortions.

That will leave a Bozeman clinic with the largest patient load in the program for low-income Montanans and the expectation that more are on the way, which its staff have said they’re ready for.

Planned Parenthood announced this week it’s pulling out of the federal program Title X rather than follow the new Trump administration rule banning participating clinics from referring abortions or treating people in the same building where abortions take place.

Planned Parenthood of Montana has five Title X clinics that covers about 45% of the roughly 18,000 Montanans who benefit from the sliding fee scales the federal dollars help create.

President and CEO Martha Stahl said while Planned Parenthood of Montana is withdrawing from the money, its clinics will continue to offer the same services for patients.

“There will be folks in the state of Montana, I am sure, that will go without care because of this rule change because they may not know about the services still available and options for coverage,” Stahl said.

She said Planned Parenthood will help balance the loss by making sure people sign onto state programs that help cover family planning like Montana’s Medicaid expansion and Medicaid waiver program called “Plan First.”

Not everyone qualifies for that support, including people younger than 18.

“We’re going to make sure our patients know where they can go,” Stahl said. “Some will have to travel because Title X providers don’t have an overlap in our service areas and public health doesn’t know the confines of county lines.”

About 4 million women are served nationwide through the Title X program, which distributes $260 million in family planning grants to clinics, according to the Associated Press.

Montana’s roughly $1.9 million in federal money for the program connects people to testing for sexually transmitted diseases, birth control, annual exams and cervical cancer screening. That money has to remain separate from abortion services, though some against the procedure have called it an indirect subsidy.

Enforcement of the new Title X rule marks a major victory for a key part of President Donald Trump’s base that long campaigned to “defund Planned Parenthood” because among its list of services, it’s also the largest abortion provider in the nation.

More than 100 public health organizations opposed the changes, saying they would dwindle participating providers and cut off people who rely on those services.

Stahl called the new rules dangerous. They mean if a woman walks into a Title X clinic and asks where to get an abortion, the provider can’t answer her. Instead, the provider can offer patients a list of prenatal care providers.

“But many organizations that provide abortion services are not comprehensive prenatal care providers and most comprehensive prenatal care providers don’t provide aboriton care,” Stahl said.

A federal appeals court in San Francisco is weighing a lawsuit to overturn the rules, though the enforcement has moved ahead.

In the buildup to the rule change over the last year, Bridgercare in Bozeman weighed whether it would step away from the money as it spoke out against the rules.

Director Stephanie McDowell said Thursday they likely won’t withdrawal.

“It’s a really gut-wrenching decision. I think financially it would be a real hurdle for us,” McDowell said. “We’re still waiting for understanding on how to implement the rule in a setting where we don’t do abortions and we’re hoping for some work around so that patients feel empowered.”

The clinic received $150,000 for the program this year. That’s down from its typical $300,000 a year as the state has sent money to clinics around Montana.

Bridgercare Development Coordinator Emily Allison said there’s another reason to remain in Title X. How much funding Montana gets for the family planning program largely depends on how many people use the service.

She said while Bridgercare receives only about 8% of the state’s pool of money, it serves closer to 37% of Title X recipients.

Allison said with Planned Parenthood out of the program — which would likely drop the state’s number of recipients — Bridgercare’s patients suddenly make the state’s majority.

“We fully support Planned Parenthood of Montana’s choice and that they’re providing services no matter what. It’s an honor to work with them,” Allison said. “But since they do feel forced to leave the program, then we’re kind of what’s left, the other big one.”

She said Bridgercare is prepared to receive those dislodged from care.

The clinic recently moved to a new building in part to expand its services and reach more people.

“We’re lucky because we own our clinic thanks to the support from our community and that saves us money,” she said. “We also know that rural health care options are shrinking for a lot of reasons.We’re not surprised we might be seeing people travel hours for care. We’re ready.”

It will be another few weeks before final lines are drawn on which Montana providers stick with the program and who opts out.

Jon Ebelt, a spokesman with the Montana Department of Public Health and Human Services, said the agency hasn’t received any official notification from Montana Title X providers about their plans with the new rules.

“However, we have been in contact with them, and will continue to work with each provider in the coming weeks,” Ebelt wrote in an email.

The state agency has until Sept. 18 to show the federal government it will comply with the rules. As part of that, the department has until Sept. 13 to collect statements from clinics opting to stay that promises they’ll follow the rules.

Katheryn Houghton can be reached at or at 582-2628. Follow her on Twitter @K_Hought.

Katheryn Houghton is the city government and health reporter for the Bozeman Daily Chronicle.

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