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Montana politics, elections and legislative news

New Medicaid Expansion Work Requirements Could Affect 26,000 Montanans

Gov. Steve Bullock is joined by Rep. Mary Caferro, a Democrat from Helena, and Rep. Ed Buttrey, a Republican from Great Falls, and other lawmakers for the signing of HB 658, May 9, 2019. The bill reauthorizes the state's Medicaid expansion program.
Corin Cates-Carney
Montana Public Radio
Gov. Steve Bullock is joined by Rep. Mary Caferro, a Democrat from Helena, and Rep. Ed Buttrey, a Republican from Great Falls, and other lawmakers for the signing of HB 658, May 9, 2019. The bill reauthorizes the state's Medicaid expansion program.

New analysis from the state health department shows the new Medicaid work requirements set to take effect on Jan. 1 will apply to more Montanans than expected — up to three times more.

The Montana Department of Public Health and Human Services is in the middle of writing new rules for work and public service requirements into Medicaid. The contentious health coverage program for low-income adults is run by the state, and the federal government picks up 90% percent of the costs.

Continuing Medicaid expansion in Montana was a big question in this spring’s legislative session. A group of Republicans worked against their party leadership, joining with all House and Senate Democrats to continue Medicaid. The law they passed introduced some significant changes.

The new law makes half-time work, community service or substance abuse rehabilitation mandatory for some adult Medicaid recipients, and increases premium costs for enrollees who stay on the program longer than two years.

DPHHS medical director Marie Matthews was unsure how the changes would impact enrollment.

“Because work and community engagement requirements are a new policy, and there's very little national precedent operationally, it’s impossible to predict the future enrollment effects with certainty,” Matthews said. “And so there is the possibility that coverage losses could be greater.”

When state lawmakers debated the policy earlier this year, the final fiscal impact note from the governor’s office projected roughly 8,100 current enrollees would be required to participate in or report compliance with the new requirements.

With the law now in place, the draft report from DPHHS said the number could be nearly 26,000.

The new estimate is based on watching New Hampshire’s roll out and subsequent analysis of its own work and community engagement requirements, according to the department. Nearly 17,000 people in New Hampshire reportedly failed to meet that state’s law within the first month.

In an emailed statement, Montana DPHHS spokesperson Jon Ebelt wrote “these analysis and experience shows increasing awareness of the complexity of such a program.”

Yesterday, a federal judge blocked Medicaid work requirements in New Hampshire.

Mary Caferro, a Democrat from Helena, supported continuing the health coverage program and sat next to Gov. Steve Bullock at the bill’s signing. But on Tuesday she had worries about the new requirements.

“I continue to be concerned about the impact of work requirements on access to health care,” she said.

Before Montana can start putting those requirements in place, the federal government must first sign off on the plan.

John Esp, a Republican senator from Big Timber, said the new requirements don’t go far enough. His stance echoed concerns raised by other Republicans during the 2019 legislative session.

“I just think that working is very important and 80 hours per month is not a lot” Esp said.

“When I was living below the federal poverty level with my family, I worked 60-70 hours a week, and we made it work, and I bought health insurance. I think we should require more than 80 hours, but probably that's what the law is.”

The state health department said a vast majority of the 92,000 Montanans receiving coverage through expanded Medicaid are already working. They and many others, the department said, would not have to report their compliance under the new law because they’re working, or fall under exemptions including those for medically frail individuals, the mental or physical inability to work, or primary caregiver status.

The health department is taking public comment on the latest draft of the new Medicaid expansion system. You can attend meetings Wednesday in Billings and Thursday in Helena either in person or via webinar. You can also submit comments by mail or email. Public comments are due by Aug. 23.

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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