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HELENA — When Gov. Brian Schweitzer submits his farewell state budget in November, he’ll spell out how Montana should expand Medicaid in 2014 to provide health coverage for another 50,000 of our lower-income fellow citizens — or maybe not.

Schweitzer, whose final term in office ends Dec. 31, isn’t saying whether he wants to expand Medicaid in Montana, as allowed and bankrolled by the federal health reform law.

In a recent interview, the Democratic governor said his administration wants to know the ground rules for the expansion, such as whether Montana can make some adjustments and still get federal financing.

“Ultimately, (the cost) will come back on the shoulders of the states, so before we enter (into an expansion), we want to make sure we have the tools to challenge expenses,” he said. “We’re going to look at all the options, but first we want to know what all of our options are.”

As it happens, Schweitzer is not alone in his curiosity. Many states are asking many questions about just how the Medicaid expansion might work, in the wake of the U.S. Supreme Court decision in June that made the expansion optional for the states.

And so far, the feds don’t have the answers.

Mike Fierberg, spokesman for the Center for Medicare and Medicaid Services regional office in Denver, said last week his agency and its parent, the U.S. Department of Health and Human Services, are still working on potential rules.

The Supreme Court ruling essentially rewrote the law on the Medicaid expansion, making it optional for the states instead of required in 2014 – but nothing in the law contemplated or speaks to an optional program, he said.

“Since the Supreme Court put the decision-making power with the states, we’ve been examining what is legal under the law, and what might not be, in terms of what we can allow and what we cannot allow,” Fierberg said.

The 2010 law had said states must expand Medicaid in 2014 to cover all people earning up to 138 percent of the federal poverty level, or about $20,000 for a household of two.

Medicaid, funded by the state and federal government, provides virtually free medical and nursing-home coverage to the poor and disabled.

The law also said the feds will cover the entire cost of the expansion from 2014-2016 and then start gradually reducing its share to 90 percent by 2020.

Fierberg said states are peppering his agency with questions about how the optional program will work. Must states opt in or opt out? Is there any discretion on whom or what is covered? When do states have to decide? Can they reverse course, once they make a decision?

There’s no telling when decisions will be out, he said.

And then, of course, there’s the question of who wins the Nov. 6 presidential and congressional elections, as Republicans have promised to repeal the health care law if they take over.

In the meantime, states like Montana will at least start thinking about what decision they’ll make, since any expansion would require legislative action, and the Montana Legislature meets only once — next year — before the 2014 deadline.

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Schweitzer is likely to put something in his proposed state 2013-2014 budget, which he has to submit six weeks before he leaves office.

Then it’s up to the next governor and Legislature.

Republican gubernatorial candidate Rick Hill has said he sees potential problems with the expansion, and that he won’t support it if it “puts Montana taxpayers at risk and increases the cost of health care in Montana.”

Steve Bullock, the Democrat running for governor, said it’s hard to know what path to take until the feds define the parameters of the expansion.

He said he wants to figure out how Montana can control health care costs and expand availability, and whether the Medicare expansion could achieve those goals.

Republicans are likely to be reluctant to expand government-funded coverage, while Democrats say Montana should give it a look, and that it could be a positive force.

“I tend to believe the Medicaid expansion would be a good thing for Montana,” said Rep. Chuck Hunter, D-Helena, a member of the House Human Services Committee. “But I’m still cautious about the financing. I’d like to see a really good analysis of all the ins and outs of what an expansion would bring to us.”

Sen. Max Baucus, D-Mont., a key figure in writing the law, said he supports the right of Montanans to choose on Medicaid expansion – but clearly has an opinion on whether it’s a good thing.

His office said last week that Montanans should know the facts before they decide. For example, it said, if Montana doesn’t participate, our taxes will support health care in other states and we’ll pay more in private insurance to pay for a higher rate of uninsured people. And if we do participate, it said, 7,000 additional veterans and their families will be covered.

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