MTPR

Montanans Covered Through Medicaid Expansion Need 'Skin In The Game', Republicans Say

Jan 30, 2019

A new proposal to continue Montana's Medicaid expansion program surfaced at the state Capitol Wednesday. It offers the first peek at the eagerly anticipated Republican bill to modify Medicaid expansion in the state. That's the program that extends health coverage to around 95,000 low income Montanans.

Montana Public Radio Capitol Bureau Chief Corin Cates-Carney joins us now to talk about it.

Corin Cates-Carney: This sketch that's in the works for what Medicaid expansion's future in Montana could look like is called the Medicaid Reform and Integrity Act. The bill's sponsor Republican Representative Ed Buttrey sometimes calls this bill "MeRIA" for short. And the clock is ticking on the state's current program that expires in less than six months. So today we got our first look at the plan to replace it.

Edward O'Brien: I'm sure we could go real deep in the weeds here, but basically what are the takeaways for how this new proposal could change how people get health coverage from the expansion program?

Cates-Carney: So, leading up to the Legislature at this point, some Republicans have been calling for people who receive health coverage through the Medicaid expansion program to have what they're calling 'skin in the game.' The bill draft I have says there will be an 80-hour per month requirement to enroll in community engagement for certain people covered by the expansion program. This is something that's been long speculated over whether it would be included, and it's drawn some criticism from Democrats and Governor Steve Bullock, who point to legal challenges to workforce requirements in other states.

I was able to chat with Representative Ed Buttrey Wednesday afternoon, and he said that this is something that he knows is going to get a lot of debate moving forward.

“We certainly don't want to put in a requirement that's  punitive," Buttrey said. "I don't want to — I'm not trying to do something that's going to cause the enrollment numbers to drastically change. You know, we've really all along been about a principle of skin in the game. If you're benefiting from the program, you need to help the program succeed.”

Cates-Carney: Buttrey says these requirements will likely decrease the number of enrollees in the program. He said he doesn’t expect a big dip, but didn’t give an exact number.

A document outlining some of these new proposals said there would be a time window, maybe around 180 days, for current Medicaid enrollees to come into compliance with this new requirement.

O'Brien: You mentioned community engagement. Is that the same thing as community benefit requirements then; work requirements?

Cates-Carney: So, it could be hours worked on the job. It could also be hours spent in a substance use disorder treatment, it could be different types of counseling. And so, the details are still getting worked out about what this will and won't include. And when that happens there will be some exemptions for people. A drafting document says some people who are full time caregivers will be excluded from this. People with disabilities, people over the age of 65, pregnant women in their last trimester. So there would be some exclusions here. But again, the details are still getting worked out.

O'Brien: Speaking of details, is it too early to ask how, potentially, the state will incorporate these changes?

Cates-Carney: It is still pretty early. This proposal would significantly change the current Medicaid expansion system, and we're not sure yet how the Bullock administration is going to respond to this. It's very likely that this will be debated in the coming weeks and months.

O'Brien: Everything boils down to money Corin, as you know. What will the new costs amount to, and what do we know about things like staff needed to run the program?

Cates-Carney: Some of the criticism leading up to this Republican bill draft coming from Democrats and Governor Steve Bullock is that imposing these kinds of requirements and enforcement could end up costing the state more money to administer than it would end up saving through finding potential bad actors in the system.

Buttrey says he thinks these additions to the Medicaid expansion program could be added without additional staffing to the state, or costs. However, at the same time he says there will be some lift for the state.

"It certainly is going to be a bit more of a burden," Buttrey says. "But we are utilizing taxpayer money for this program. We do have some fiduciary responsibility, and I don't think we've done a really good job making sure that the state has accounted for taxpayer money being spent; the right people, they're still eligible, they still meet the income level. We've got to do a better job."

Cates-Carney: Medicaid expansion is still largely paid for by the federal government and it will continue to be that way moving forward if it remains past its current expiration date in a few months. But Montana's share of the cost is scheduled to increase slightly. To help pay for the state's increasing cost for the program Buttrey's plan would set up a new fee on hospital revenues for outpatient services, as well as expand some insurance premium tax on health insurance companies.

O'Brien: The concerns about costs aside for the moment, generally speaking Corin, how are Democrats and Governor Steve Bullock responding to these documents today?

Cates-Carney: This is all pretty new so we haven't seen them come out with specific thoughts on the bill draft. But Governor Bullock’s office did tell The Associated Press that Bullock has some concerns that several of the provisions in the bill are against federal law. Also, some Democrats are still moving forward with their own plan to continue Medicaid expansion.