HELENA — The bill that would remove the sunset date on Montana’s Medicaid expansion program has passed the Legislature and could soon be on its way to the governor – but that doesn’t mean lawmakers are done discussing Medicaid expansion.
Expansion was expected to be a major topic throughout the 69th legislative session, but House Bill 245, which renews the program, passed a final vote in the Senate on Thursday – well before the session’s halfway point.
“I think it's nice to get it done before transmittal, and to know that there were enough representatives and senators that understood the benefits that the program’s providing to our citizens and to our businesses,” said Rep. Ed Buttrey, R-Great Falls, who sponsored HB 245.
(Watch the video to hear how leaders think federal action could affect Medicaid expansion.)
During the legislative debates over Medicaid expansion, those opposed to an extension often argued the federal government is likely to cut back its financial support for the program – federal dollars currently cover 90% of the costs – and that any reduction could force the Legislature to return for a special session to deal with the fiscal impact.
National media reports have said the House Republicans’ budget resolution could require at least $880 billion in spending cuts from the committee that oversees Medicaid, to provide savings that can fund the extension of President Donald Trump’s 2017 tax cuts.
Buttrey said, regardless of what Congress may do in the future, the Legislature has to plan for the way the law currently is.
“I'm not so sure it's going to be as easy as some of these folks may think to have Congress have to go back to their states and say, ‘Look, we're either going to knock a whole lot of people, low-income working folks, off of coverage, or we're going to have to tax our taxpayers even more to continue the program,’” he said. “I'm not so sure that that's going to be as easy as people would think. But if we do have to come back for a special session, this is a program that affects 76,000, 80,000 Montanans – that is a reason to come back and have the debate.”
Last week, members of Montana’s congressional delegation were in Helena to address the Legislature. MTN asked Republican U.S. Reps. Ryan Zinke and Troy Downing to comment about the possibility of cuts in federal support for Medicaid expansion.
Zinke said, when it comes to big programs like Medicaid, Medicare and Social Security, the first priority should be to look for savings by improving efficiencies. He said he’s convinced leaders will be able to make significant savings by identifying abuse and fraud.
“$7 trillion and there’s not one case of fraud?” he said. “Enough's enough. So on the savings side, I think we all should agree to look at eliminating the fraud, waste and abuse.”
Downing said he’s been frustrated that federal authorities haven’t granted Montana a waiver that would let the state implement “community engagement” requirements – requiring those on Medicaid expansion to spend 80 hours a month on work, education, workforce training, volunteering or other approved activities. However, he said he expects the Trump administration will grant that waiver. He said Medicaid remains a “lifeblood” for Montana, especially in rural communities.
“What happens on the federal side remains to be seen; we'll see what that committee work looks like,” he said. “But I will tell you that I will advocate to make sure we're still supporting what we need in Montana.”
Buttrey said, because of some federal court decisions, he thinks it would likely take congressional action to make community engagement requirements part of Medicaid expansion.
“We designed our system as an economic development program to get people working; the vast majority of them do work or caretake or are in school,” he said. “So the implementation of those work requirements isn't punitive to our program. It would not result in many people being taken off the program.”
There are still bills up for discussion that would further adjust Medicaid expansion. On Monday, the House endorsed House Bill 687, from Rep. Bill Mercer, R-Billings. It would require people on Medicaid expansion to follow the community engagement requirements – once implemented – until age 62. The law currently exempts people over 55.
Mercer said he has been doubtful that the community engagement rules would actually be implemented, but he thought it was now more likely based on the conversation at the federal level.
“We have an awful lot of people in the workforce today, that you engage and you see in communities all the time, that are over the age of 62 that are working,” he said. “It seems inappropriate that we would have the expansion population participants that would be immune from these requirements merely because they have reached the age of 55.”
The House also gave initial approval to House Bill 601, from Rep. SJ Howell, D-Missoula. That bill would create an online portal, to make it easier for people to get someone to help them with applying for Medicaid or going through an eligibility redetermination. Howell said it was a response to many constituents reporting issues with the process during an eligibility review in 2023 and 2024.
“There were folks ready and willing to help with this application or redetermination process, but they didn't have a good process to do so,” said Howell.
