MTPR

Montana Republicans, Democrats Square Off Over Medicaid Expansion's Future

Mar 14, 2019

The State Legislature will be in session on Saturday to take up what's arguably the biggest issue of this year's legislative session: Medicaid expansion.

The two parties will introduce bills with clashing visions for how to continue the state’s health insurance program for low-income adults, which expires in just over three months.

Republicans officially introduced their plan earlier this week after months of speculation.

House Bill 658 calls for significant changes, with the stated goal of getting more low-income Montanans off the government healthcare program and into jobs that allow them to afford private coverage.

And, they want adults who aren’t elderly, sick or disabled to be required to work in return for Medicaid benefits.

Some Medicaid policy experts say work requirements would result in many Montanans losing their healthcare.

“So this bill really targets a tiny, tiny share of Medicaid beneficiaries, but because of all of the extra red tape and paperwork, could end up have harmful effects far beyond just that subset,” says Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities, a left-leaning think tank based in Washington, D.C.

At the beginning of February, more than 96,000 adults were enrolled in Medicaid expansion in Montana.

The Republicans’ bill would require an estimated two-thirds to either work 80 hours a month or enroll in what it calls “community engagement activities.” Those include a paying job, workforce training, behavioral health treatment and other activities.

And, they’d have to report on a quarterly basis that they are meeting the requirements, or be disenrolled.

“The only state that has actually taken coverage away from people who aren’t meeting a work requirement is Arkansas," Katch says. "And what we’ve seen in Arkansas over the past, about nine months, is that 1-5 people who are subject to the requirement have lost coverage.”

A study from George Washington University released Thursday, found that the work requirements and other measures in the Republican bill would cause more than half of current expansion enrollees in Montana to lose their health coverage -- some 50 to 56,000 people.

As of Thursday afternoon, 18 House Republicans and nine in the Senate have signed on as co-sponsors to House Bill 658.

Democrats in the Legislature have so far taken a hard line stance against the bill, opposing additional requirements on enrollees.

The minority party is pushing forward their own legislation, House Bill 425. It would maintain the expansion status-quo, continuing the bi-partisan compromise enacted in 2015. It would, though, add funding to an existing workforce training program that has won bipartisan support for its effectiveness.

Dozens of hospitals and healthcare organizations around the state are also opposing Medicaid expansion work requirements. Advocate groups are planning a rally to support the current expansion policy at the state capitol at noon Saturday.

Some Republicans are also opposing the Medicaid expansion bill coming from within their own party.

Like Denise Lenz, the Chair of the House Human Services Committee, where both the Republican and Democratic parties’ bills will be heard Saturday. Lenz doesn’t support the Republican bill, because he says it’s work requirements may not go far enough.

“And is 80 hours a month enough for us? I’m not certain it is.”

Many Republicans are concerned about state costs. The federal government will soon cap its share of expansion expenses at 90 percent.

Lenz also says members of his caucus want to tighten the guidelines on enrollees self-reporting that they’re meeting the work requirement. Critics say that will add a lot of administration and cost to the state, Lenz says he’s not worried about that.

“I don’t have any concerns about their ability to do it with existing staff. As to whether they’ll do it with existing staff is another story.”

Republican leadership in both the House and Senate also want any continuation of Medicaid expansion to have a sunset, so lawmakers can debate the issue again in four years. The Democrats’ bill would make expansion permanent.

Lenz says a political strategy is in place to hold a Medicaid expansion bill from Gov. Steve Bullock’s desk until the final days of the legislative session.

This could pin Bullock between signing a bill he dislikes, and his party opposes, or vetoing it, potentially leading to a special session. Bullock could be faced with this decision as the clock winds down on the current Medicaid expansion policy, which expires at the end of June.