The 96,000-plus Montanans currently covered by Medicaid expansion can breathe a sigh of relief — along with their families, employers and health care providers. The Legislature finally approved continuation for at least six years of the program that offers needed health care to low-income Montanans regardless of age or disability.
Montana hospitals, physicians, nurses, faith leaders, advocates for low-income families and health care organizations produced mountains of data confirming the benefits of Medicaid expansion since it started here in 2016. The University of Montana Bureau of Business and Economic Research estimated that the program had created 5,000 jobs statewide and will put about $400 million a year in new spending into our state economy. Medicaid expansion assisted thousands of enrollees in getting jobs or advancing to better jobs. Overall, the proportion of low-income people in our state workforce grew faster did participation by other income groups.
Newly covered Montanans got preventive care and tests for cancer, diabetes and other chronic illnesses. Montana hospitals saw a sharp drop in uncompensated care (charity and bad debt) and most saw their operating income improve, allowing struggling nonprofit hospitals to keep their doors open. Some have also been able to invest in better services for their entire community.
Despite the well documented benefits of Medicaid expansion, its renewal beyond the June 1 sunset date wasn't a certainty until the Montana House approved it on third reading Thursday. House Bill 658 is heading for the desk of Gov. Steve Bullock, a champion of covering Montana's low-income workers.
Bullock's support was crucial, but no Medicaid bill with a Democrat's name on it could pass this Republican majority legislature. Rep. Ed Buttrey, R-Great Falls, sponsored HB658, which was extensively amended as members of his party argued for more restrictions on eligibility, requirements for 80 hours of work per month, verification and reporting requirements, an assets test, higher premiums and fees for enrollees, audits to ensure that no enrollees were cheating, audits to hold the Department of Public Health and Human Services accountable. Ultimately, a compromise emerged that increases the state's administrative costs and is projected to result in about 4,000 people being dis-enrolled for failure to comply with new rules.
Originally, HB658 said that if a court threw out any of its requirements, the entire program would end. Fortunately, that was changed so if "a court of final disposition" rules against the work requirements (as lower courts already did) the program would still continue until June 30, 2025.
As Montana hospitals had agreed months ago, they will pay most of the state's share of Medicaid expansion through increased fees and a new tax. The federal government will pay 90 percent of care costs and about half of administrative costs.
State legislators concerned with making enrollees have "skin in the game" with premiums didn't do much to reduce the state's costs. By federal law, any premiums or fees the state collects from enrollees have to be shared with the federal government in proportion to its 90 percent match. So Montana keeps only 10 percent.
Higher DPHHS costs
The assets test some Republicans insisted on would have affected about 65 of 96,000 enrollees, according to the fiscal note. There won't be many enrollees with real estate, vehicles or agricultural lands that requires them to pay a monthly fee starting in July.
Carrying out the new "community engagement" and "taxpayer integrity" requirements will necessitate additional DPHHS hiring, perhaps around 20 people, according to the most recent fiscal note for HB658.
It would have been better to keep the program simpler, to recognize the bipartisan success of the 2017 HELP Act and to continue with that more efficient law.
Buttrey's bill still does an enormous amount of good for our state. Medicaid expansion is the primary payer for addiction treatment, making it crucial to dealing with the meth and opioid crises. Medicaid is a major source of access for Montanans needing mental health care. Medicaid covers a substantial number of pregnant women who otherwise would have no insurance.
Billings 'no' votes
In Montana's largest city and medical center, it is dismaying to note that not one of our Republican lawmakers voted for HB658 on final passage. All Democrats statewide voted for continuing health care, along with Republicans from other counties.
Even Rep. Rodney Garcia and Sen. Tom Richmond, who signed on as cosponsors, voted against Medicaid last week. Reps. Daniel Zolnikov, Sue Vinton, Terry Moore and Dale Mortensen voted yes on second reading Thursday morning. Vinton, Moore and Mortensen then voted no on final passage Thursday afternoon. Zolnikov was absent for the final vote.
If Medicaid had been solely up to legislators in Yellowstone County, it would have failed.
Thanks to the 61 Montana representatives and 28 senators who voted for good health, healthy workers and families and passed HB658. Thanks to the hundreds of Montanans who traveled to Helena during the past few months to tell their health care stories to lawmakers, and thanks to the dozens of Montanans who shared their opinions on Medicaid in Voice of the Reader letters.
Let's celebrate this healthy renewal and dedicate ourselves — regardless of politics — to make the revamped program work as well as possible for enrollees, taxpayers and our state economy.