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Medicaid expansion success meets legislative skepticism

As the Montana Legislature considers renewing the Medicaid program it created four years ago, lawmakers have good data from the first three years to show its success.

One significant source of research on the Medicaid expansion program is a report written last spring by Bryce Ward and Brandon Bridge of the University of Montana’s Bureau of Business and Economic Research. The report was supported by the Montana Healthcare Foundation and Headwaters Foundation,  based in Bozeman and Missoula, respectively.

Among Ward's and Bridge’s findings:

  • “Medicaid expansion will introduce approximately $350 million to $400 million of new spending to Montana’s economy each year.”
  • It generated about 5,000 new jobs statewide.
  • “While the state pays a nominal amount for these benefits, the costs to the state budget are more than offset by the savings created by Medicaid expansion and by the revenues associated with increased economic activity.”

In 2016, the first year of Montana Medicaid expansion, the federal government paid 100 percent of its health care costs. The state’s share is gradually rising to 10 percent, the maximum allowed under federal law.

Medicaid expansion has been a godsend to the community hospitals, clinics and treatment centers who care for Montanans regardless of their ability to pay. The program dramatically reduced charity care and bad debt, and cut the losses that small Montana hospitals see on annual operations.

Montana’s largest hospitals have the biggest caseloads of patients who cannot pay. Those who have insurance pay for charity care and bad debt through higher charges and higher insurance premiums. Medicaid expansion helps reverse some of that cost shift.

Some Montana lawmakers have criticized Medicaid expansion as being too expensive and covering people who don’t deserve publicly funded health care. Critics say there must be stricter eligibility rules and work requirements.

In fact, 70 percent of the Montanans enrolled in Medicaid expansion are working. Most of the rest are sick, injured or caring for children, elders or disabled family members.

Data collected by the Montana Department of Public Health and Human Services shows that among 94,594 Montana adults in the Medicaid expansion program on Nov. 1, 2018, 89,055 had received preventive health screenings that resulted in diagnosis and treatment for:

  • 102 women with breast cancer.
  • 1,929 adults with high blood pressure.
  • 878 adults with diabetes.

Medicaid expansion has improved access to mental health care and addiction treatment for alcohol, meth, opioids and other drugs. As of November, Medicaid expansion had covered outpatient mental health services for 29,556 adults and inpatient mental health care for 3,193. It had covered outpatient addiction treatment for 7,421 Montanans and covered residential treatment for 1,963 people.

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Without this Medicaid program that covers poor people regardless of their age, thousands of Montanans would have no way to pay for the mental health care, addiction treatment or medical care they need to recover. Without health care, they are less likely to be able to work.

One of the unique features of Montana Medicaid expansion, also called the HELP Act, is connecting enrollees to the Montana Department of Labor and Industry for help in finding and holding onto jobs.

The BBER researchers found more low-income people entered the Montana workforce after Medicaid expansion took effect in January 2016. That increase in workforce participation didn’t occur with higher-income Montanans, nor did it occur with low-income folks in other states.

Montana is one of 32 states to adopt Medicaid expansion. In November, voters in Idaho, Utah and Nebraska approved initiatives to start Medicaid expansion. No state has rescinded it because it is a good deal for needy people and for the state budget.

Montana must continue its successful program to make the most prudent use of limited public funds.

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