Montana Medicaid expansion bill squeaks through Legislature

A bill that would extend the Medicaid expansion program passed the state legislature last week, though support for it was split by local lawmakers.

Sen. Dee Brown, R-Coram, voted against House Bill 658 and Rep. Zac Perry, D-Martin City voted for it. Ed Buttrey, R-Great Falls, was the bill’s main sponsor.

Brown said she voted against because of the cost to the state. She noted it had a big fiscal note, but the bill didn’t go through what she considered to be the proper channels. She predicted that in the future Montanans will end up paying for more and more of the program.

The bill passed 61-35, just hours after accepting Senate amendments. It now goes to Democratic Gov. Steve Bullock, who is expected to sign it.

“This is a good day for Montana,” Bullock said in a statement last week. “We have once again demonstrated that when we put partisan politics aside and come together to do right by Montanans, government can make a meaningful impact in people’s lives.”

The action came on a busy day as lawmakers moved toward wrapping up the session this week.

Democrats and moderate Republicans supported the Medicaid program and reached a compromise between two proposed bills — one that would have continued the program much as it has been since 2016 and another that would have killed the program if the federal government rejected work requirements.

The bill contains a “community engagement” requirement of 80 hours per month for individuals between the ages 19 and 55. Employment counts as community engagement, but so do other services, like attending college, workforce training, substance abuse education or treatment and other activities that “promote work or work readiness or advance the health readiness of the Medicaid program.”

There’s also several exemptions to the community engagement requirement, including being legally disabled, pregnant, a foster parent, chronic homelessness or “living in an area with a high poverty designation.”

A person can also have another income that exceeds what they make if they had worked 80 hours per month at minimum wage and still qualify.

It also strengthens an asset test, increases premiums for people who remain on the program for more than two years, and requires Hutterite colonies to pay the state’s share of coverage for their members.

It also adds a tax on hospitals to leverage more federal funding. The Senate amended the bill to allow the health department to verify an applicant’s income with the Department of Revenue and included a June 2025 expiration date.

If the bill hadn’t passed, the program would have ended on June 30.

It’s estimated that the program could bring about $720 million in federal funding into the state in each of the next two fiscal years.

Opponents argued the program is not sustainable, contributes to federal deficit spending and there are too many exemptions to the work or community engagement requirements.