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The Montana State Capitol

Byron Weaver finally got tired of working all the time and not making enough money to pay the bills.

The 52-year-old was handcrafting saddles, a line of work that takes a lot of skill and hours and hours of time.

It’s a job Weaver loves, but the economics of a meticulously produced product made with expensive materials was starting to wear on him.

“The truth is it was just hard to make a living because everything was done by hand,” Weaver said. “It was just tough being a one-man shop to put out enough to make a living. For a long time I was in the back of my mind thinking about changing careers because I wasn’t earning enough money, but I was good at what I was doing so I kept struggling along.”

With an income that put him in a range to qualify for Medicaid expansion, Weaver signed up awhile back. Along with the health insurance, he got a piece of mail informing him about HELP-Link, the voluntary workforce program lawmakers created along with expanding Medicaid in 2015.

Weaver wasn’t immediately interested, until one day when he hit a point where he wanted to explore jobs that would pay better.

“I had just stuffed it behind my computer. I’d see it every day,” Weaver said of the flyer with a number to call for workforce services. “I thought why not check it out and see what’s available.”

That phone call connected Weaver with the local Job Service office, and that led to a career assessment test to see what type of work might fit him. Computer technology, the medical field and agriculture rose to the top of the list for Weaver, and now he’s one semester and 18 credits away from a degree in computer technology with a certificate in programming. It's a job that will pay better than saddle-making and is in high demand.

As Montana lawmakers begin a debate over how to continue Medicaid expansion and if the program should include some sort of work requirements as a part of eligibility, the voluntary workforce program Weaver went through has moved into the spotlight.

Medicaid expansion is set to expire in Montana this summer unless lawmakers vote to extend it. First passed in 2015, the Montana Health and Economic Livelihood Partnership Act, better known as the HELP Act, extended Medicaid coverage to those earning up to 138 percent of the federal poverty level. That’s $15,418 a year for an individual or $26,347 for a family of three.

As part of the deal to get bipartisan support in 2015, lawmakers created what members from both parties have praised as a Montana-specific approach to opening a path to employment. That's the HELP-Link program, meant to help those not already working find employment and people who have jobs but want to improve their situation get help doing so. About seven in 10 people covered under Medicaid expansion in Montana are already employed.

'Skin in the game' 

An early draft of the Republican bill to continue expansion this year includes what the bill sponsor calls “community enhancements,” or requirements of 80 work hours, volunteering or other activities a month. That's different from HELP-Link's voluntary nature, although HELP-Link would continue to exist.

The work requirement comes in Rep. Ed Buttrey's bill. Buttrey is a Republican from Great Falls who carried the original Medicaid expansion legislation in 2015. He believes work requirements, which he said ensure people on the HELP Act have "skin in the game," and the voluntary program can exist together successfully.

The option for work requirements didn't exist in 2015, but became an option after President Donald Trump signed an order in April 2018 allowing them. 

Arkansas is one of seven states that added work requirements as a condition of its Medicaid eligibility since Trump's order. Since June 1, more than 18,000 people in that state were unenrolled because they did not comply with the requirements, according to a report from the Kaiser Family Foundation. That’s out of 234,385 covered on expansion there, or about 7 percent.

Buttrey said Friday he's not trying to duplicate Arkansas's approach in his bill, which he stressed is still an early draft that includes exemptions for caregivers, students and more.

"We're not duplicating Arkansas," Buttrey said. "You hear them talk about Montana innovation and a unique solution. In 2015 we had these same arguments that other states have tried this and it won't work, but we did it. I'm not trying to copy Arkansas or anybody else. We're coming up with a Montana solution."

That solution also includes a $3.5 million grant program for the voluntary workforce program. The program also has budget authority for $1.8 million in the two-year budget.

Numbers from the Department of Labor and Industry, which administers the program, shows since 2016 more than 25,000 people enrolled in eligible types of Medicaid have gone through career and training services. About 70 percent of those people found jobs in the first year after training. About 58 percent of people who went through some sort of training saw their wages increase, by a median of $8,060.

The numbers for people who went specifically through the HELP-Link program — about 3,000 in two years — saw better outcomes, likely because of the increased intensity of the programs, according to the department. 

Buttrey's grant money would go to private employers who train and hire people going through HELP-Link. The Department of Labor and Industry has already started similar programs, including one with Benefis Health System in Great Falls to train and hire certified nursing assistants.

"There ought to be some benefit to them for doing that because they're helping the whole state," Buttrey said.

Democrats say the HELP-Link program is all that the workforce development people covered under Medicaid expansion need, arguing work requirements would kick people off health insurance — just as has happened in Arkansas. They've proposed a bill to continue Medicaid expansion in its current form.

Rep. Casey Schreiner, the minority leader in the House, said he thinks Buttrey's bill looks fairly similar to Arkansas' program.

"The (Republican) proposal … appears to put people into work environment that is just counting hours and not actually talking about upskilling, and I think that’s a detriment to the program," Schreiner said. "I think that what you're going to find if that's the direction this body goes, what we're going to see is a slower pace of growing our economy. We're going to see businesses with less skilled workers."

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Kevin de Liban, an attorney with Legal Aid of Arkansas who has spent the last several years working on cases related to that state’s Medicaid work requirements, said last week voluntary programs like Montana's are a better approach.

“You don’t need to do something like threaten to take away somebody's health care to get someone to be working or trying to improve their skill set. … Instead focus on just offering volunteer workforce development services that are really meaningful that will provide people skills and job training. … You can trust that people are going to act rational. You can trust that people are going to try to do their best,” de Liban said.

High-demand jobs

Scott Eychner is the administrator of the Workforce Services Division in the Department of Labor and Industry. He said participants in the HELP-Link program are going into high-demand jobs like health care, which has benefited the state's economy. Seven of the top 10 professions people going through the program pursue are in the health care field. There's also been high participation from rural communities, where it's even more difficult to attract workers.

“I would love to be able to sit here and tell you we strategically set that up,” Eychner said. “That’s part of the great success for us in what this program does. … They opted to go into health care fields and that’s where we have seen some of our hardest-to-fill health care needs. The rising tide of that has been fantastic.”

Shawna Auge, of Libby, is another program participant. Unlike Weaver, the saddle maker, she was already in a state assistance program that does require work hours to get benefits. That's the Temporary Assistance for Needy Families program, which has an hours requirement for cash benefits.

That program brought Auge to the Job Services Office, where she got connected with the HELP-Link program and started to explore career options.

“I think the program is really important because I was a stay-at-home mom and my kids’ dad went to jail and I was like ‘What do I do?'’’ Auge said. She explored bartending but because of the hours it was difficult to find child care.

Then she saw a posting for a job at an insurance company. Auge started looking up the requirements for the position and learned she needed to take classes in Missoula and then a state licensure test.

The HELP-Link program helped her accomplish that by paying for school in Missoula and the gas to get there from Libby. The program even picked up her hotel room and a rental car when she hit a deer during her drive to Missoula.

“I wouldn’t have been able to afford any of it,” Auge said. “I couldn’t even afford the gas to get over there.”

Auge loves her new job, which pays well enough that she bought a new car and her first home. HELP-Link also paid her employer for the first three months of her employment while she learned the necessary skills and got licensed.

Because she came to HELP-Link from a program that required work hours, Auge said she supports some sort of similar requirement in the Medicaid expansion program.

“I honestly think making work required is a good thing because I feel like when I was in the program, there are just so many people who get things given to them and if they don’t have to work for it, and it’s volunteer they’re not going to choose to do that. I don’t like sitting at home. I like working and I wanted a better job," Auge said.

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