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Montana politics, elections and legislative news

As Clock Ticks On Medicaid Expansion, Montana Democrats Criticize Republican Plan

Montana Capitol building.
Nick Mott
Montana Public Radio
Montana Capitol building.

A day after the long-anticipated Republican plan to continue Medicaid expansion was revealed, House Democrats reacted with strong criticism.

"Frankly, right now, I don’t know what there is to negotiate about,” says Casey Schreiner, the Democratic House minority leader.

An early outline of the Republican plan to continue the state’s health care program for low-income adults by Great Falls Rep. Ed Buttrey suggests significant changes.

It would establish what Buttrey calls “community engagement requirements,” for certain Medicaid recipients.

“The idea of the program, for this population, is to help people get healthier both mentally and physically. To help them, if possible, to get better employment, move onto the exchange, move into business with a company that provides benefits like health care. And that’s the real intent of the program.”

Buttrey carried the 2015 bill that expanded Medicaid in Montana, which passed the Legislature and was signed by Gov. Steve Bullock. Now, Buttrey says people who receive health coverage benefits should in exchange have “skin in the game.”

His so-called Medicaid Reform and Integrity Act would require some recipients to either work or participate in behavioral health or substance use disorder treatment, community service or other activities. They’d also be subject to health risk and job readiness assessments. The outline also calls for a new grant program to incentivize businesses to hire low-income workers.

On Thursday, Democrats pushed back on that idea. They had an attorney from Arkansas to phone into a meeting in the Capitol.

Last year, Arkansas became the first state to implement and enforce workforce requirements since the Trump administration allowed states to attach Medicaid coverage and mandatory work.

Kevin De Liban represents people on low enough incomes who qualify for Medicaid and says the requirements didn’t turn out well. He says they’re illegal and result in people having trouble navigating the new system and losing health coverage.

“The state doesn’t have any basis on which to say that the work requirements have been successful. If anything, it’s that the opposite has been true. Tons of people have been terminated.”

Arkansas requires enrollees in expanded Medicaid to work or participate in community engagement activities for at least 80 hours a month. Months after implementation, thousands of people enrolled lost their coverage for failing to comply.

Arkansas is among nine states with federally approved or pending work requirements for Medicaid expansion adults, according to analysis from the Kaiser Family Foundation.

Arkansas and Kentucky are both currently being sued over theirs.

Rep. Buttrey says his draft plan to require Medicaid recipients who are able to participate in 80 hours a month of community engagement requirements, “Will result in the program enrollment decreasing, but I don’t think by much. And I hear the government saying, ‘we’re going to spend money just to route out a few bad actors,’ but we have that responsibility to taxpayers. This is taxpayer money.”

It’s unclear how much the state would have to spend to enforce the work requirement, and how much it might save by disenrolling those who fail to meet it. A detailed list of activities that would count toward those requirements and who is exempted is still getting worked out.

The draft of the bill calls for the state to review Medicaid expansion enrollees’ compliance of the requirements four times a year.

Buttrey says it is not the goal of these requirements to drastically change the enrollment level in Montana’s Medicaid expansion program.

Democrats are working on their own bill to continue Montana’s Medicaid expansion program.

Rep. Mary Caferro, a Democrat from Helena, plans to carry it. No draft of it is available, but Caferro says it would remove the sunset from Montana’s current Medicaid expansion program.

“What we have in Montana is a Medicaid expansion program that works.”

And Caferro says Democrats are proposing a $3 million-a-year increase to the current workforce element of Montana's program. Participation in that is voluntary. It offers participants help finding jobs and learning skills that help them get employed. House Democrats do not yet have a plan to pay for that funding increase.

A Democratic bill to maintain the status quo on Medicaid expansion appears unlikely to win enough Republican support to pass. The Republican majority could potentially pass Buttrey’s bill without any Democratic votes. That could put Democratic Gov. Steve Bullock in the difficult position of vetoing it with the clock ticking on Medicaid expansion, which is scheduled to expire at the end of June.

Corin Cates-Carney manages MTPR’s daily and long-term news projects. After spending more than five years living and reporting across Western and Central Montana, he became news director in early 2020.
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