MTPR

Medicaid Expansion Reform Policy Advances Under Tight Deadline

Mar 26, 2019

A policy to continue Medicaid expansion in Montana has passed its first vote in the state Legislature. The bill includes what some are labeling as work requirements for so-called able-bodied adults enrolled in the program.

The House Human Services committee voted 11-8 Tuesday evening to approve a heavily amended House Bill 658, carried by Republican Rep. Ed Buttrey.

Buttrey sponsored the 2015 bill that first approved Medicaid expansion in Montana. Without reuathorization by the Legislature, the policy that now provides health coverage for around 96,000 low-income adults will expire at the end of June.

Like in 2015, the new version of the expansion is backed by Democrats and moderate Republicans.

Democratic Rep. Kim Abbott is a House Minority Whip.

"It is a pretty significant compromise, from my view," Abbot says.

Changes made to the bill just before Tuesday’s vote carved out political compromises that might be needed to advance the policy in the final weeks of the 2019 session.

Democratic leadership had said ahead of the vote that they opposed the policy that included new requirements, like work, from certain people on expansion.

House Bill 658 requires 80 hours a month of so-called community engagement requirements from certain Medicaid expansion enrollees.

However, Abbott says that expanding the list of exemptions from those requirements — like exempting people experiencing chronic homelessness — helped sway Democrats to vote in favor of the bill.

She also says the revised policy reduces some of the burden for state government in administering the new requirement.

Abbott says the bill also includes a clause that could protect the entire expansion, even if a court were to strike down a portion of it.

But most Republicans on the House committee were uncomfortable with the sudden changes. Several Republicans on the committee, including Rep. Forrest Mandeville, said they could not support a bill that changed so much right before they cast their vote.

"Agree or disagree with Medicaid expansion, we’re still talking about nearly around 100,000 people," Mandeville says. "And we’re impacting a very important part of their lives. And I’m not comfortable with, basically, a substitute bill that hasn’t gone through the process that we’ve had for the bill before amended. I’m just not sure what the impact is going to be."

Mandeville was among the eight Republicans that voted against House Bill 658. Three Republicans, including Buttrey, joined Democrats in supporting it.

Before amended, a study by George Washington University said Buttrey’s bill would result in about half of Montanans enrolled in the Medicaid expansion program being dropped from coverage.

A fiscal impact review of the bill done by the Governor's Office of Budget and Program Planning said that costs to the state would be similar to the current program while providing coverage to significantly fewer people.

Republicans raised concerns Tuesday evening about voting on the amended bill without an updated cost analysis from the state.

Rep. Barry Usher, a Republican from Billings said Buttrey’s bill no longer resembles the bill that was introduced.

"Everything that most of my constituents were saying, 'if we have to have Medicaid expansion, I want this, this, this, this'; and you took them all out. That is not the bill we had hearings on."

Rep. Ed Buttrey walked the middle ground during the committee meeting that stretched into the evening. He said that although there have been changes to ease concerns raised about the bill, it still effectively accomplishes the same goals.

"Those same requirements that were in the bill — the community engagement, the 80 hours, the exemptions, the disenrollment — everything that was in the original bill is still in this bill. So to say that those requirements and all the things we liked and were promised in the beginning are gone, that's absolutely not true," Buttrey says.

A Democratic bill, carried by Rep. Mary Caferro was tabled. It proposed to keep the state’s Medicaid expansion program going as-is, with increased funding to the current optional workforce training program.

Buttrey’s bill, sometimes referred to as the Medicaid Reform and Integrity Act, now moves to the House floor for debate. It faces an April 1 deadline to advance to the Senate.