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MEDICAID EXPANSION STATES

Montana’s Health and Economic Livelihood Partnership Act has helped businesses in every county as it provided health care coverage to low-income workers, including folks with multiple part-time and seasonal jobs over the past three years.

That statement is backed up by a report this month from the Montana Department of Labor and Industry, which found that more than half of Montana businesses had at least one employee enrolled in the Medicaid expansion authorized by the 2015 HELP Act. Most of these employers are small businesses: 62 percent have fewer than 10 employees. However, 98 percent of Montana businesses with 50 or more employees had at least one HELP Act enrollee last year, according to the DLI report. Altogether, 84 percent of Montana’s private sector businesses had a HELP Act enrollee on the payroll.

Much attention has been paid to ensuring that people receiving government-funded health coverage are working. That was true in the 2015 Legislature when the HELP Act was written and some 2019 lawmakers have said they want stiffer work requirements.

In 2018, 67 percent of the 96,000 Medicaid expansion enrollees were working and 80 percent lived in a family that had at least one worker, according to Montana DLI. Among the 33 percent who weren’t employed, the vast majority were either in school, too sick to work or taking care of children, disabled or elderly relatives. Only 4 percent were unemployed for “unknown reasons.”

The HELP Act provided for moving those 4 percent to employment and to helping those already working get better paying jobs. However, it is important to remember that 96 percent of enrollees already had jobs or couldn’t work. The DLI HELP-Link program could be most helpful to the small minority “not working for unknown reasons.”

Another feature of the 2015 HELP Act ensured that enrollees “had some skin in the game.” Lawmakers insisted that enrollees who could pay something for their coverage and care be required to do so. The law says that enrollees whose income is between 50 percent and 138 percent of poverty (annual income for one person between $6,000 and $16,753) must pay 2 percent of their income as a monthly premium. The Montana law says that enrollees must be charged the maximum co-pays allowed by federal law.

Enrollees who fail to pay their monthly premium can expect that the payment will be withheld from any future income tax refunds. Those whose income is above poverty level can be dis-enrolled for nonpayment. Federal law prohibits cutting off people below poverty.

Data on the employment of HELP Act enrollees shows how the federal and state tax money spent on this program works across our great, big state. The HELP Act supplies coverage that would cost employers several thousand dollars a year per worker if purchased on the private insurance market. The law provides health care access for low-income workers on the job and between seasonal jobs. HELP helps people get healthy and stay healthy enough to work.

HELP also created about 5,000 new jobs statewide, according to a 2018 study by the University of Montana Bureau of Business and Economic Research.

Most HELP Act enrollees already work if they can. Any changes in requirements, reporting and verification must be carefully written to avoid making compliance so onerous that Montana workers lose coverage. Legislators must take care that regulations don’t cost more than they “save.”

Medicaid expansion makes sense for Montana families, workers and businesses. The HELP Act is a great success that should be sustained so all Montanans have access to needed health care.

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