HELENA — After several years and a long, bumpy road to passage, the governor signed a bill into law Wednesday to expand Medicaid eligibility to about 70,000 low-income Montanans.
Democratic Gov. Steve Bullock signed the Montana Health and Economic Livelihood Partnership Act into law in the Capitol rotunda as hundreds of people cheered.
"We got this done, and 70,000 Montanans will no longer have to wait," Bullock told the crowd. "There truly might not be any more important legislation this year than HELP."
The compromise proposal was introduced by Republican Sen. Ed Buttrey of Great Falls in March after lawmakers defeated Bullock's plan.
The new law would accept federal funds to expand Medicaid eligibility to people with incomes at or below 138 percent of the federal poverty level — or about $16,200 per year for an individual and $33,460 for a family of four.
It also would require people who enroll in the program to pay health care premiums and co-payments for certain services. Additionally, all those who choose to enroll would be asked by the state Department of Labor to participate in a workplace assessment survey for the creation of a job placement plan that could include training. It would focus on existing job needs and new health care jobs created through Medicaid expansion.
"We are proud to have crafted a plan that goes beyond just providing health care, but also serves to help our poorest citizens find a pathway out of poverty," Buttrey said. "Our plan is a unique, Montana-made solution that gives its members the responsibility for their health, and economic livelihood."
Buttrey calls the plan the most conservative in the nation due to the co-pays, premiums and other provisions. Because of those items, the state must seek a waiver from the federal government to put the program in place.
Bullock said his staff will draft the plan and allow Montanans to comment on it before submitting it to the federal government. Once they receive it, Bullock said the waiver process could take from three to six months although there's no required timeline for approval.
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"We're pushing government further than any state has," Buttrey said.
Buttrey estimates that, if approved, only about 45,000 people of the 70,000 eligible will sign up for Medicaid in the next four years at least in part due to the copay and premium requirements.
Stephanie Wallace of Troy, a Head Start teacher with a husband out of work, said they make too much money to qualify for federal subsidies on the health exchange and too little to pay the high costs of health insurance.
"This is personal for me," she said Wednesday. "Being uninsured is scary."
She also said the job training piece of the law could be a boon for her husband and could help their family in the long-run.
As originally enacted, the Affordable Care Act required states to expand Medicaid to adults earning up to 138 percent of the federal poverty level. A U.S. Supreme Court decision in 2012 made the expansion optional for states. In 2013, a Montana measure to expand Medicaid died by one miscast vote.
The federal government will fully fund the expansion until 2020, after which states will be responsible for 10 percent of the costs. Many Republicans who opposed expansion said they didn't believe the federal government would live up to their funding promises.
The Montana law is written to sunset in four years, but it could be kept alive by future legislatures. Montana is the 29th state to expand Medicaid, along with the District of Columbia.