Medicaid Expansion Passes State House, Heads to Senate

On Saturday March 30, the Montana House passed House Bill 658 with a vote of 61 in favor to 37 opposed. The bill, if passed in the Senate, will continue Montana’s Medicaid Expansion program that features a 9 to 1 match in funds from the Federal Government and provides health care to over 96,000 Montanans according to the Department of Health and Human Services. That number equals roughly 9.4 percent of the state’s population.

Both Montana House Representatives for Valley County, Casey Knudsen (R) and Rhonda Knudsen (R), voted against advancing the bill to the Senate.

R. Knudsen said her vote on Medicaid expansion reflected the opinion of the people in her district. “I voted with the people of my district that voted against Medicaid expansion,” said Knudsen in response to questions from the Courier. She also expressed concerns about additional tax revenues that would be required to fund the new law, but provided no specifics.

In an email response to questions, C. Knudsen voiced his concerns about the bills long-term viability. “My main issue with the bill is it is an unsustainable program,” stated Knudsen. “Especially when, not if, the federal government starts reducing the cash flow to the state.”

“I realize we need to come together to take care of the people who cannot care for themselves, and I have no issue with having a program in place to do so,” explained the two-term representative from Malta. “What I do not agree with is this massive expansion of Medicaid to include, as we have seen over the past 4 years, people who have the ability to work and care for themselves but choose to let the government do it for them because it’s easier.”

If expansion fails the state would still be obligated to pay for “traditional Medicaid” that would apply to Montanans below the poverty line. Failing to pass expansion would cut coverage to those between 100 percent and 138 percent of the federal poverty line. For a family of three the poverty line is $21,330 and 138 percent of that is $29,435.40 based on numbers on the U.S. Department of Health and Human Services website. That means that a single parent of two children earning $14.15, or less, an hour would no longer receive health care under Medicaid if the program lapsed.

According to a Department of Labor and Industry report published in January, 62.1 percent of Valley County businesses (110 in total) employ persons enrolled in Medicaid expansion. That same report found that nearly 70 percent of all Medicaid enrolled persons are employed. Under the ACA a business must provide health insurance if they employ more than 50 people, but most of the employers of Medicaid recipients in Montana are small businesses.

C. Knudsen did not respond to a follow-up question seeking clarification by press time.

He also expressed concerns that the bill was rushed through the legislative process. “This bill came out of the gate as one thing, was heavily amended in the Human Services Committee,” wrote C. Knudsen, “[W]e only had about two days to look this bill over and investigate the changes before the vote on the house floor.”

Senator Mike Lang, who represents the Hi-Line from Havre to Bainville, told the Courier, “Medicaid expansion is going to happen. One way or another it’s going to happen.” The Senator said he was going to vote in favor of the expansion depending on the committee decisions and amendments to the bill that he anticipates will be added during debate in the senate. He did not clarify the amendments.

Lang did express concern that the expansion would have “winners and losers” because funding would have to be shifted around to pay for the program. “What I want, what my personal opinion is, is that we are not taking care of our elderly enough through long-term care,” said Lang, “So, the reason that it gets cut, is we don’t have enough money to go around.”

HB 658 originally sought to continue Medicaid expansion permanently but was amended to include a sunset clause of six years while still in committee. That means that the legislature will have to pass expansion again in 2025. Among the sunset clause, other reforms in the bill added “community engagement” and work requirements for participants in the program.

Those requirements state that participants 19 and older but younger than 55 must participate in 80 hours of community engagement activity a month.Those activities include work readiness and training; secondary, postsecondary, or vocational training; substance abuse education or treatment; and other work related activities that promote work or worker readiness. Exemptions for the program apply for people unable to meet the requirements for various reasons such as health issues.

Chief Executive Officer of Frances Mahon Deaconess Hospital Randy Holom told the Courier that the hospital is publically in support of Medicaid expansion but not for financial reasons. Holom stated that due to the nuances of critical access hospitals and the transfer of traditional Medicaid participants to the expansion program the numbers more or less come to a wash for FMDH. Holom said that the hospital’s motivation for being in support of the program is due to the health of the community.

“Financially, it was sort of neutral,” said Holom, “It didn’t help or hurt us.” The CEO went on to explain that most people who had been uninsured prior to expansion had often put off seeking medical care when they were first in need. As a result of the delays, people were often worse off health-wise and the level of care was usually higher and more costly. Medicaid expansion has benefited the community by allowing the newly insured to seek immediate care, which pays off in health outcomes and lower costs.

A separate Medicaid expansion bill, House Bill 425 was tabled in committee and will likely die there. That bill would have extended the Medicaid expansion program indefinitely and would have kept it more or less the same as it is today.