Medicaid expansion renewal heads to the governor's desk

By Leia Larsen

Montana Free Press

HELENA — After a turbulent ride through the Montana Legislature, a bill extending Montana’s Medicaid expansion program cleared its final legislative hurdle Thursday.

House Bill 658, carried by Rep. Ed Buttrey, R-Great Falls, revises the state’s Medicaid program considerably. While the bill’s short title describes the legislation as generally revising health care laws and “permanently” expanding Medicaid, amendments added by the Senate add a sunset date of June 30, 2025. That means lawmakers will again need to evaluate the program in a future session.

Senators also increased a fee on hospital outpatient revenue to help cover a bigger share of program’s cost, and amended the bill to include income verification requirements.

Montana lawmakers first made Medicaid expansion law in 2015 under the HELP Act. It currently covers about 96,000 low-income people making less than 138 percent of the federal poverty level.

Republican lawmakers voiced concerns that the program enrolled more patients than initially estimated. Some claimed that out-of-state residents, able-bodied adults, and those with wealthy land holdings were gaming the system. Buttrey drafted HB 658 to include conditions for residency, work requirements, and tighter asset-testing measures.

The House approved the Senate’s amendments in an 87-13 vote during second reading Thursday morning. A few hours later, on third reading, the chamber voted 61-35 to send the bill to the governor’s desk, with several Republicans flipping their votes.

The HELP Act would have expired this summer if legislators did not authorize the extension.

Democratic lawmakers, including Gov. Steve Bullock, initially spurned the addition of another sunset provision and work requirements, advocating that the HELP Act be made permanent and kept largely intact.

The minority party ultimately got on board with the changes, and spun Thursday’s vote as a victory.

“Since Legislative Day One, Democratic lawmakers promised that we would not walk out of this building without passing Medicaid expansion,” House Minority Leader Rep. Casey Schreiner, D-Great Falls, said in a press release. “Today, we did exactly that. Medicaid expansion has created thousands of jobs, thrown a lifeline to our rural hospitals, and provides critical health care for one in 10 of our neighbors.”

The Montana Hospital Association, which supported both parties’ efforts to renew the HELP Act, praised lawmakers for finding a compromise.

“We’re grateful for the bipartisan team of legislative leaders in the House and Senate who were willing to reach across the aisle because they know Montana Medicaid works,” said Rich Rasmussen, the association’s CEO, in a press release.

Other bumps on HB 658’s road to the governor’s desk included an effort by some GOP lawmakers to tie the bill’s fate to Senate Bill 331, the controversial “Save Colstrip” proposal. A handful of senators led by Sen. Duane Ankney, R-Colstrip, initially refused to give the expansion bill their vote of approval in order to send a message to Democrats and the governor.

A few of those senators, including Ankney, ultimately flipped to support HB 658 in the waning hours before a transmittal deadline.

Meanwhile, SB 331 failed to garner enough votes in the House, but the bill could make a reappearance in the last week of the session. A conference committee could add the legislation to a related energy bill, House Bill 597, through amendments.

Buttrey’s Medicaid expansion bill now goes to the governor’s desk, where it will likely be signed into law.

“This is a good day for Montana. 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,” Bullock said in a press release.