Second bill to restrict Medicaid expansion goes down, but one to help participants heard

A bill to help people stay on Medicaid for 12 months without having to submit and resubmit paperwork unnecessarily would save time and money, supporters said this week.

Sponsored by Rep. SJ Howell, D-Missoula, the bill would ensure parents, caretaker relatives, and Medicaid expansion participants won’t have to reapply if they only have slight changes to income.

The policy, called “continuous eligibility,” is already in place in Montana for children and pregnant women, Howell said.

They said it is good for people’s health to have consistent coverage, and it streamlines administrative processes.

“I think we could consider this a red-tape relief bill,” Howell said.

The bill, House Bill 386, includes an aspect of Medicaid expansion.

A separate bill, House Bill 245, would keep Medicaid expansion in place and will be up for a hearing in the Senate Public Health, Welfare and Safety committee on Monday after clearing the House.

This week, the Senate voted down a couple of other bills that would have restricted or phased out Medicaid expansion, although with warnings that the Legislature could find itself in a special session given anticipated cuts at the federal level.

Rep. Ed Buttrey, R-Great Falls, is sponsor of House Bill 245, to continue Medicaid expansion. Buttrey said he does not believe a precipitous drop is imminent, and Montana must plan based on current law, not on “what ifs.”

“Federal law has funding at 90-10. That’s how we plan for it today because that’s the federal law,” Buttrey said. “If the federal law were to change, we would potentially have decisions to make.”

Buttrey said he believes the chance Congress will reduce funding quickly is low. Currently, the state puts in $1 for every $9 from the feds.

“I don’t think we’ll see a massive drop, if any,” Buttrey said of federal support. “If Congress did say, ‘We do want to reduce the (match),’ I believe it would be over time, so they would give states a chance to adjust.”

If the match falls below 90%, to continue the program, the Legislature would have to appropriate money, the state would have to apply for a waiver to increase premiums to people in the program, or a combination of both.

One day after voting down a bill to slowly sunset the program, the Senate turned down a bill by Sen. Jeremy Trebas, R-Great Falls, that would have tied the program to work requirements, currently written into Montana law, but not approved at the federal level.

Proponents of Medicaid expansion, which allows people at 138% of the poverty level to be insured, point to data that show small hospitals are on the ropes and will face closures without it.

Trebas, though, said the health care system is already in trouble, and the smaller hospitals are a symptom, and larger ones are sinking, too.

“Small rural hospitals are simply the canary in the coal mine,” Trebas said.

The Senate voted down his bill, Senate Bill 199, on a 23-27 vote with nine Republicans joining Democrats in opposition.

In the House Human Services committee, proponents of continuous eligibility said it helps seasonal workers, and it helps hospitals and clinics have less uncompensated care and account for fewer uninsured patients.

A fiscal analysis said it will cost $5 million to implement in just the first year and $10 million the second year, and Howell acknowledged — “I won’t lie” — the bill requires big money up front.

However, they said the savings will be substantial, and the legislation will mean more Medicaid dollars going to health care instead of paperwork and bureaucracy.

“That’s the goal of the program, to ensure that people are healthy,” Howell said. ” They’re able to care for themselves and their families, get to work and participate in the community.”

Supporters said it improves health because people don’t avoid care, helps people seeking treatment for addiction stay in recovery, and uses taxpayer money efficiently.

Jennifer Hensley, on behalf of the Montana Academy of Physician Assistants, said she would appeal to the frugality of legislators.

“If not passing this, you’re stepping over dollars to pick up dimes, and that wouldn’t make sense,” Hensley said.

Other supporters include the Montana Medical Association, the Montana American Indian Caucus, the Montana Budget and Policy Center, the American Heart Association, and Catalyst Montana.

The committee did not take immediate action on the bill Thursday.