Montana Legislature Green Lights Medicaid Expansion as Congress Considers Program Cuts

BY  HANNAH SCHOENBAUM

A Republican proposal to leave current levels of Medicaid coverage in place in Montana is headed to the governor’s desk as Congress considers billions of dollars in cuts to the low-income health program.

The Montana Senate gave final legislative approval to the bill in a 30-20 vote Thursday. Expanded coverage had been set to expire on the safety net program that insures more than 76,000 Montana residents. Republican Gov. Greg Gianforte has voiced support for continuing coverage, but has not commented on the specific proposal.

A coalition of moderate Republicans and Democrats carried the bill across the finish line, after effectively wresting control of the Senate agenda from conservative GOP leaders in recent days. The measure includes new work requirements for some Montana Medicaid enrollees, criteria that had been blocked under former President Joe Biden.

In 2015, Montana lawmakers voted to extend Medicaid coverage to adults between the ages of 18 and 65 with annual incomes slightly higher than the federal poverty level. Before the Affordable Care Act let states extend coverage to this group, the program was limited to disabled, pregnant and elderly people, and children in low-income households. It now insures nearly 80 million people nationwide.

The state renewed the expanded program in 2019, but set an expiration date for this summer. Under the latest bill, lawmakers would no longer need to periodically renew the program.

State Rep. Ed Buttrey, a Great Falls Republican and the bill’s sponsor, said the program has been a lifeline for low-income residents and the state’s rural health care providers, which no longer need to spend as much money caring for uninsured patients.

Medicaid expansion has especially benefitted Montana’s Native American population, improving health outcomes and treatment access, while taking the strain off the overburdened Indian Health Services.

Most states receive extra federal funding for expanding Medicaid coverage to more residents. In Montana, the federal government currently foots about 90% of the $1 billion annual bill.

Republican opponents such as state Sen. Carl Glimm of Kila warned Montana could soon be saddled with much higher costs if Congress cuts funding for the states. The $880 billion Medicaid program is a prime target for the GOP-controlled body as it looks to slash federal spending.

Montana is one of nine states with trigger laws automatically or almost automatically ending Medicaid expansion if the federal government decides to cover less of the cost. Its law requires the state to identify additional funding if the federal contribution rate drops.

U.S. House Speaker Mike Johnson has also floated imposing work requirements, which would limit Medicaid coverage to qualified people who are actively working, volunteering or otherwise engaging in their community. Montana and other states have previously attached work requirements to Medicaid expansion plans, but they were blocked from taking effect by the Biden administration.

About 92% of Medicaid enrollees are already working, attending school or caregiving, according to an analysis by the health policy research firm KFF.

The bill headed for Gianforte’s desk renews the state’s own push for work requirements, which President Donald Trump’s administration may be more likely to approve.

“It’s a safety net we need to have, but we also have to make sure the people that get in the safety net doesn’t cause the safety net to collapse under its weight,” Gianforte said recently.

Republican governors in Arkansas, Iowa and Ohio have also announced plans to seek approval from the Centers for Medicare and Medicaid Services to introduce work requirements. South Dakota voters signed off last year on a plan to add a similar rule, which also requires federal approval. About 18,000 people lost coverage when Arkansas enacted work requirements during the first Trump presidency but those were later blocked by a federal judge.