HELENA — If the Republican plan to replace the Affordable Care Act becomes law, Montana could end its Medicaid expansion program, which has opened up coverage options for many Native Americans.

Known as the Montana Health and Economic Livelihood Partnership, or HELP, Act, Medicaid expansion increased eligibility to those earning up to 138 percent of the federal poverty level. Statewide, 9,916 Native Americans signed up for coverage.

Under the GOP plan, many states that expanded Medicaid would end their programs because of a drop in how much the federal government reimburses states for the people it covered.

In Hardin at Bighorn Valley Health Center, Dr. David Mark said that would have a negative effect.

Medicaid expansion was “really a game-changer in terms of connecting so many people in our community and in our region for the first time ever have really been connected to access to health care now,” Mark said. “It’s really allowed people to access care in a whole new way.”

Bighorn Valley Health Center in Hardin is a specific model of delivering health care through a public-private partnership model to places where it’s been historically difficult to access. Under the center’s umbrella are satellite offices in Ashland, Colstrip and St. Labre school in Ashland that deliver a mix of medical, behavioral and oral health care, as well as substance abuse treatment. 

The HELP Act has provided tribal members with freedom of choice for the first time, Mark said.

“For the folks on the reservation and in tribal communities to have options, particularly when it comes to primary care and then also specialty care, to get items taken care of before they become a big deal, it’s been super beneficial.”

After expansion Mark said he noticed a clear pattern: The number of uninsured patients dropped by the same percentage Medicaid patients expanded. Uninsured patients went down 9-10 percent. Medicaid payments to the center increased too, jumping $557,000 from what they were in 2014.

If Medicaid expansion were to go away, it would be a "significant blow."

“Our ability to do integrated care well and provide a full menu of services to take care of the whole person would really be restricted. And most patients agree that’s the stuff that really makes a difference and not the few minutes with a harried physician," Mark said. "I’m hopeful that the expansion of Medicaid in this state and across the nation will not go away because we’re really just beginning to get into it."

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Reporter covering statewide issues for The Billings Gazette.