Abortion is legal in Montana and protected by the state constitution. Under Montana abortion laws, you have a constitutional right to end a pregnancy up to fetal viability, and after viability when a treating provider determines in good faith that the abortion is medically indicated to protect your life or health. A handful of statutory rules still apply, mostly around informed consent, reporting, provider licensing, and notification for younger minors.
The Constitutional Right
Voters approved Constitutional Initiative 128 in November 2024, and it took effect on July 1, 2025. The amendment states that “there is a right to make and carry out decisions about one’s own pregnancy, including the right to abortion.”1Ballotpedia. Montana CI-128, Right to Abortion Initiative (2024) The government cannot burden that right unless it can show a compelling interest, pursued through the least restrictive means. A government interest counts as compelling only if it “clearly and convincingly addresses a medically acknowledged, bona fide health risk to a pregnant patient and does not infringe on the patient’s autonomous decision making.”
The amendment also protects people who help someone else obtain an abortion, and it bars the state from penalizing anyone based on their pregnancy outcomes. This is a stronger and more explicit protection than the case-law right Montana had previously relied on under the state constitution’s privacy clause.
When Abortion Is Legal
Montana permits abortion up to fetal viability. The Abortion Control Act defines viability as “the ability of a fetus to live outside the mother’s womb, albeit with artificial aid,” and creates a presumption that a fetus is viable at 24 weeks of gestational age.2Montana State Legislature. Montana Code 50-20-104 – Definitions If there is uncertainty, the presumption favors viability. The treating physician or physician assistant makes the viability call in writing, based on an ultrasound and the best available survival data.
After viability, an abortion is still allowed when it is necessary to preserve the patient’s life or health. If it is done to preserve health rather than life, two additional licensed physicians must examine the patient and concur in writing that the abortion is necessary, and the provider performing the procedure must document the specific medical facts supporting the decision. Those procedural steps do not apply when the abortion is needed to save the patient’s life. CI-128 layers on top of this: the government can never block a post-viability abortion that a treating provider determines in good faith is medically indicated to protect life or health.1Ballotpedia. Montana CI-128, Right to Abortion Initiative (2024)
Who Can Perform an Abortion
Abortions in Montana are no longer restricted to physicians. In 2023, the Montana Supreme Court struck down the criminal statute that had prevented advanced practice registered nurses from providing abortion care, finding it unconstitutional. APRNs include nurse practitioners and certified nurse midwives, and the evidence before the court showed they provide abortion care with the same safety and quality as physicians and physician assistants. This matters in rural Montana, where physician access is thin.
Facilities that perform surgical abortions or dispense abortion medication to five or more patients per year must be licensed as abortion clinics. Hospitals, critical access hospitals, rural emergency hospitals, and outpatient surgical centers do not need separate abortion-clinic licensure because they already operate under their own standards. The state inspects licensed clinics annually and can deny, suspend, or revoke a license for noncompliance.3Legal Information Institute (LII). Mont. Admin. r. 37.106.3102 – Minimum Standards for Abortion Clinics: Licensing
Rules for Minors
Parental consent is not required. In 2024 the Montana Supreme Court struck down the Parental Consent for Abortion Act of 2013, holding that it violated minors’ fundamental rights to privacy and equal protection. The court wrote that “a minor’s right to control her reproductive decisions is among the most fundamental of the rights she possesses” and found the state had not shown a real connection between the consent requirement and any legitimate purpose.4Justia Law. Planned Parenthood v. State
A separate, older parental notification law still applies to unemancipated minors under 16. The provider must notify a parent or legal guardian in writing or by phone at least 48 hours before the procedure. Notification is not required if the provider certifies a medical emergency and that there is not enough time to give notice. Notification means the parent must be told; it does not mean the parent must agree.
Informed Consent and Reporting
Before an abortion, the physician must disclose the nature of the procedure, medical risks, gestational age, and alternatives. The consent has to be in writing and signed by both the physician and the patient.5Montana State Legislature. Montana Code 50-20-106 – Informed Consent Informed consent is not required in a medical emergency, and coercing someone into having an abortion is separately prohibited.
The statute also contains a 24-hour waiting period between informed consent and the procedure. Its enforceability is uncertain: a separate 2021 waiting-period law for medication abortion has been struck down, and CI-128 now subjects any burden on abortion access to heightened scrutiny.
Every facility performing abortions must file a report with the Department of Public Health and Human Services within 30 days. The report covers prior pregnancies, the procedure used, gestational age, any fetal vital signs after the procedure, and for post-viability abortions, the steps taken to preserve fetal life and health.6Montana State Legislature. Montana Code 50-20-110 – Reporting of Practice of Abortion Reports are treated as confidential medical records, and only non-identifying statistical data is published.
Paying for an Abortion
Montana Medicaid covers medically necessary abortions. That coverage traces to the 1995 district court ruling in Jeannette R. v. Ellery, which held that excluding abortion from otherwise comprehensive Medicaid coverage violated the state constitution’s privacy and equal protection guarantees.
The legislature tried to narrow that coverage in 2023 with HB 862 (limiting public funds to cases of rape, incest, or life endangerment) and HB 544 (restricting the definition of “medically necessary” and barring non-physician providers from Medicaid reimbursement). Both were permanently enjoined by the district court, and the Montana Supreme Court affirmed in 2024.7Justia Law. Planned Parenthood v. State (DA 23-0287) Medicaid patients accounted for roughly 36 to 50 percent of patients at Montana’s major abortion providers in 2023.
The federal Hyde Amendment still bars federal Medicaid dollars from paying for most abortions,8Legal Information Institute (LII). Restrictions on Abortion Funding but Montana pays with state funds what federal law will not cover.
Montana does not require private insurance plans to cover abortion, and it does not prohibit coverage either. Marketplace and employer-sponsored plans set their own terms. If your plan does not cover the procedure and you are not on Medicaid, you will be paying out of pocket. Medication abortion generally runs several hundred dollars, and surgical procedures later in pregnancy cost more.
Where to Get Care
Montana has five abortion clinics, in Whitefish, Missoula, Billings, Great Falls, and Helena. Eastern Montana has none, so patients east of Billings often face drives of several hours each way.
Telehealth fills part of that gap. A 2021 law that would have banned telemedicine prescriptions of abortion medication was blocked in court in October 2021 and permanently struck down as unconstitutional in February 2024. Providers can now prescribe medication abortion through a telehealth appointment, which cuts the travel burden for patients in remote areas.
Restrictions No Longer in Force
Several restrictions Montanans may have heard about are not currently enforceable, because courts have struck them down or enjoined them:
- A 20-week gestational ban, permanently enjoined by a trial court as unconstitutional.
- The physician-only requirement, struck down by the Montana Supreme Court in 2023.
- The Parental Consent for Abortion Act, struck down in 2024.4Justia Law. Planned Parenthood v. State
- A 2021 telemedicine ban on abortion medication, struck down in 2024.
- A 2021 24-hour waiting period specific to medication abortion, struck down alongside the telehealth ban.
- A 2021 requirement that providers offer patients the option of viewing an ultrasound or listening to fetal heart tones, also struck down.
- A ban on dilation and evacuation procedures, enjoined and not currently enforceable.
- The 2023 Medicaid restrictions in HB 544 and HB 862.7Justia Law. Planned Parenthood v. State (DA 23-0287)
With CI-128 in effect, any new legislative restriction has to clear the amendment’s strict scrutiny test: clear and convincing evidence that it addresses a bona fide medical health risk through the least restrictive means available.
Penalties for Violations
A health care provider who violates the abortion reporting requirements commits unprofessional conduct under Montana’s professional licensing laws. The maximum sanction is a one-year license suspension.6Montana State Legislature. Montana Code 50-20-110 – Reporting of Practice of Abortion
Performing an abortion without informed consent, or otherwise violating the informed consent provisions, is a misdemeanor.5Montana State Legislature. Montana Code 50-20-106 – Informed Consent
Part 5 of the Abortion Control Act carries additional penalties tied to minors:9Montana State Legislature. Montana Code 50-20-510 – Criminal and Civil Penalties
- Coercing a minor to have an abortion is a misdemeanor. A first conviction carries a fine of up to $1,000 or up to one year in county jail, or both. A second or later conviction carries a fine of $500 to $50,000 and 10 days to 5 years in state prison, or both.
- Signing a consent form for a minor when you are not authorized to do so is a misdemeanor.
- Failure to obtain required parental or guardian consent is treated in civil court as presumptive evidence of a professional standard-of-care violation and as presumptive actual malice for damages.
Because the parental consent requirement itself has been struck down, the civil and criminal exposures tied specifically to consent may have limited practical reach going forward. The coercion penalty stands on its own regardless of how the consent rules evolve.