Rally attendees hold signs at a rally in support of reauthorizing Medicaid expansion at the Montana State Capitol on Jan. 15, 2025. (Micah Drew/Daily Montanan)
Billed as one of the biggest potential fights of the 2025 Montana Legislature, Medicaid expansion was fully approved this week by lawmakers with bipartisan support before the midway point of the session.
A number of legislators proposed bills related to Medicaid expansion, including one to slowly let it sunset that didn’t advance.
Approved Thursday in the Senate, House Bill 245, by Rep. Ed Buttrey, R-Great Falls, will continue the program mostly as reauthorized in 2019.
Senators supported it 30-20 on Thursday, and it will head to the desk of Republican Gov. Greg Gianforte, whose budget for the next biennium includes Medicaid expansion.
In Montana, nearly 80,000 adults participate in Medicaid expansion. Eligible adults earning up to 138% of the federal poverty limit qualify for the program.
Buttrey said one change is removing a requirement that the state contract out employment services, which help people get to work. Instead, he said, the Department of Labor and Industry will provide that support.
A fiscal analysis of the bill said the department will use another $125,000 to do so and be able to serve more people.
In 2024, an adult earning up to $20,783 would qualify, and a family of three earning up to $35,632 would qualify, according to data from the Montana Budget and Policy Center.
Proponents of the program have argued it is critical for a healthy workforce and stable economy, especially for small hospitals in rural communities.
Opponents warn a special session might be in the offing if the federal government changes the amount of money it contributes to Medicaid expansion, currently 90%. They also argue the federal budget and growing deficit cannot sustain the high costs associated with national Medicare and Medicaid budgets.
A work requirement was a sticking point for some legislators. The bill includes that requirement, but it isn’t approved at the federal level.
Some lawmakers wanted the program in place only if it included a strict work requirement, but others said participants already work, and the program increases labor participation for lower income people, citing a report from the Montana Department of Labor and Industry.
A bill from Democrats that would have augmented the program to include things like a customer service component and reopening some offices of public assistance was tabled early in the session.
In the meantime, other proposals related to traditional Medicaid and Medicaid expansion are still under consideration.
House Bill 386, to allow “continuous eligibility” for certain Medicaid populations to stay insured for 12 months without repeatedly having to resubmit paperwork, had been heard in the House Appropriations committee, but the committee had not taken action on it at press time.
HB 386, by Rep. SJ Howell, D-Missoula, received bipartisan support on second reading when heard on the floor, but Howell earlier acknowledged it is expensive.
Another bill, Senate Bill 187, sponsored by Sen. Jonathan Windy Boy, D-Box Elder, would expand covered services to add traditional healing.
It was heard last week, but the Public Health, Welfare and Safety Committee had not acted on it as of Friday at press time, according to the legislative tracking site.
Senate President Matt Regier, R-Kalispell, has a separate bill he said would help people return to self-sufficiency and offer a different approach to Medicaid expansion.
It includes work requirements and restricts eligibility to participants who are “able bodied” and up to 100% of the federal poverty level, among other changes.
Regier said Senate Bill 334 also aims to put the legislature more in the driver’s seat if the federal match changes. Currently, if the match changes, the Legislature would have to appropriate money, the state would have to apply for a waiver to increase premiums, or a combination of both.
SB 334 was heard this week, also in the Public Health, Welfare and Safety Committee, but the committee had not acted on it as of late Friday afternoon.