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Montana politics, elections and legislative news

Medicaid Expansion Numbers Exceed Expectations

Montana DPHHS
HELP Program Newly Enrolled Report

The special state committee set up to oversee Medicaid expansion in Montana got its first progress report since expansion began January 1.

"This is just incredible success we’re having," Marie Matthews with the state health department told the committee. "This program has already saved the state general fund about $3 million," she said.

That’s because there are about 8,000 Medicaid recipients in Montana for whom the state used to bear part of the cost.

"Those people are now eligible for 100 percent federal funding," Matthews said, "and their medical services now being funded without a state match have saved the state $3 million. And as required in this piece of legislation, that money was appropriated to the department, and because we saved it we froze it and gave it back to the general fund."

Montana’s legislature narrowly passed Medicaid expansion last year, when a handful of moderate Republicans joined all of the legislature’s Democrats to get the law to the governor’s desk. That means the federal government now pays 100 percent of the cost of all new Medicaid enrollees who make less than about $16,000 a year.

That 100 percent funding starts to ratchet down next year, and will eventually fall to 90 percent by 2020. Montana will then be responsible for the other 10 percent.

Matthews says that so far, quite a bit of federal money has passed through the state’s Medicaid program to pay doctors and other health care providers to care for the new expansion population.

"We have to date paid for $38 million in health care services for Montanans," she said.

The health department said 80 percent of those services have been for Montanans with incomes below the federal poverty level.

People with those low incomes, and all recipients of expanded Medicaid, are required to pay premiums to get coverage, which is unusual. Most other states that have expanded Medicaid don’t require premiums. Montana’s premiums are set at 2 percent of a recipient’s income, and the health department’s Matthews says the average premium is $31 a month. It’s not a given that failing to pay the premiums means will lose coverage, but Matthews says the payment rate so far is good.

"We have already collected to date 68 percent of the amounts billed for premiums," she said. "And that – we are in a mid-billing cycle, so we’re not even through this current billing, and that is everything that has been billed and collected. Sixty-eight percent of dollars-to-billed: $367,000.

"So we are seeing clients pay the premium and take responsibility for getting health care coverage and participating in the program," Matthews said, "which is exactly the goal."

Montana’s Medicaid expansion oversight committee consists of state lawmakers, as well as representatives of an insurance company and hospitals and clinics. The head of the Confederated Salish and Kootenai Tribes’ health department, Kevin Howlett, is a member. He said he recently discovered something that disturbs him.

"How can a member of this committee, Senator Keenan, introduce a bill to repeal an act that hasn’t even had a chance to get going? Howlett asked, referring to Bigfork Republican Senator Bob Keenan. Keenan has indicated that he may introduce a bill to repeal Medicaid expansion in the 2017 legislature.

"It’s called a placeholder," Keenan replied.

"That’s not an answer,” said Howlett, and then the committee moved on without further dialog on the topic.

The committee members who spoke at the hearing about the numbers the health department presented yesterday sounded pleased, but not in attendance was a member who is one of Medicaid expansion’s fiercest critics, Bozeman Republican Representative Art Wittich. Also not in attendance was committee member Ed Buttrey, the Great Falls Republican Senator sponsored the expansion bill in last year’s legislature.

At this point the health department says enrollment in Montana’s expanded Medicaid program is at about 38,000 people. That’s 15,000 more than initial projections for its first year.

Eric Whitney is NPR's Mountain West/Great Plains Bureau Chief, and was the former news director for Montana Public Radio.
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