Carly Graf, Lee Enterprises, 02/18/24
Medicaid expansion renewal, a flagship priority of the Democrats this legislative session, skirted through the conservative-leaning Senate Public Health, Welfare and Safety Committee on Monday.
House Bill 245, a moderate proposal to renew the joint federal-state program in its current form, advanced on a 6-5 vote. Two Billings-area Republicans, Senate Majority Leader Tom McGillvray and Sen. Mike Yakawich, joined Democrats in support of the bill.
McGillvray, part of the conservative Senate leadership and a known critic of federal spending, declined to comment on why he voted for HB 245.
The proposal now moves to the Senate floor for discussion and a vote by the whole chamber.
"Tom’s a smart guy,” said Rep. Ed Buttrey, the Great Falls Republican sponsor of HB 245. “You take the vote. However way, we got it.”
The federal Affordable Care Act allowed states to choose whether to participate in Medicaid expansion, which extends government-funded health care insurance to able-bodied adults making up to 138% of the federal poverty line.
Montana narrowly enacted the program in 2015 and renewed it in 2019 by a tight margin. Without action from the Legislature this session, expansion will sunset in June.
Today, around 77,000 Montanans are covered through the $1-billion-a-year program, which is almost entirely paid for with federal dollars but administered by the state. It has contributed to improved financial sustainability for rural hospitals, boosted coverage among the previously uninsured and helped increase preventative care.
Heading into the 2025 legislative session, the narrative around renewing Medicaid expansion was that it would likely once again be a battle between lawmakers to get it across the finish line. Republicans hold majorities in both chambers, marshalled by more-conservative GOP leadership in the House and Senate.
But just about one-third of the way into the session, bipartisan support has coalesced around Buttrey’s bill, a proposal that has been colloquially summed up by backers as “don’t mess with a good thing.”
HB 245 would renew the current Medicaid expansion program, including work requirements that have yet to be approved by the federal government but are expected to get greenlit by the new Trump administration. More than half of Medicaid expansion enrollees are working payroll jobs, according to a Montana labor department report.
Though the bill would eliminate Medicaid expansion’s policy sunset, the Legislature has to approve funding for the program every two years. And should the federal government change how much money it pays to states for the program — an ostensible policy priority in Washington D.C. — the law requires Montana legislators to decide how and if to continue funding expansion.
HB 245 has so far beat out three alternatives to become the frontrunner in guiding the future of Medicaid expansion in Montana.
One bill from Rep. Mary Caferro, a Helena Democrat who worked with Buttrey on crafting the original expansion legislation known as the HELP Act, would have overhauled the program by eliminating work requirements, reinstating 12-month continuous eligibility and allocating funding to re-open public benefits offices around the state.
It was tabled in committee.
Two bills from Republican senators to restrict access to expansion or phase it out entirely both made it through committee but failed to garner enough support on the Senate floor to advance.
“Over the past two months, Montanans have made their voices heard, that Montana’s Medicaid program is critical for workers, businesses and our economy,” said Heather O’Loughlin, executive director of the Montana Budget and Policy Center. “Senate Public Health’s swift action to bring this bill to the floor shows how important it is to continue this program for the state.”
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.