In Montana, a last-minute alteration to a 2019 bill set an expiration for the Medicaid expansion program, shaping what promises to be the 2025 Legislature’s most significant health care debate. This program covers medical expenses for over 75,000 low-income Montanans, costing around $1 billion annually to state and federal governments. Legislative leaders expect this issue to influence other health policies, like behavioral health funding and hospital tax status regulation.
Senator Dennis Lenz, a Billings Republican, noted, “It all kind of links together,” referring to interconnected healthcare discussions. Legislative leaders foresee the GOP’s continued efforts in pursuing abortion restrictions, despite a statewide vote affirming abortion as a constitutional right. Yet, the Medicaid expansion remains the central issue.
“This is definitely the elephant in the room,” stated Senate Minority Leader Pat Flowers, a Belgrade Democrat. The program, initially expanded in 2015 through bipartisan support, faced a sunset clause added by Senate Republicans in 2019, setting its expiration for June 30, 2025. Now, with a Republican majority and Governor Greg Gianforte at the helm, the expansion’s future hangs in the balance.
The Gianforte administration recently completed a post-pandemic eligibility reassessment, reducing enrollees from a peak of 125,000 in early 2023 to about 76,600 as of October. Gianforte’s budget proposal includes Medicaid funding but emphasizes “strong work requirements for able-bodied adults without dependents.” GOP leaders are cautious, suggesting the continuation of the program will require additional conditions.
State Rep. Ed Buttrey plans to sponsor a bill to reauthorize Medicaid expansion without a set expiration, but skepticism remains among many GOP lawmakers. House Speaker Brandon Ler expressed concerns, citing issues with what he calls “socialized medicine.”
Conservative think tanks argue Medicaid expansion’s enrollment and costs are excessive, while consulting firm Manatt highlights its role in providing critical treatment access. Republicans generally favor work or premium requirements, currently not enforced due to Biden administration policies. The incoming administration may be more open to such provisions.
Democrats tout Medicaid expansion’s success in covering thousands of workers and supporting rural health providers. They argue the state’s 10% cost share brought in substantial federal funding. Senate President Matt Regier and others suggest more government oversight on the “community benefits” hospitals provide to maintain tax-exempt status.
Governor Gianforte’s priority to enhance Montana’s behavioral health system hinges partly on Medicaid expansion. Plans include a $100 million investment over the next two years, backed by a $300 million fund established by the 2023 legislature. Democrats aim to ensure this funding addresses the most urgent needs promptly.
Despite voter approval of Constitutional Initiative 128 safeguarding abortion rights, Republicans plan to introduce related legislation. Senate President Regier emphasized the need to define CI-128’s terms, while Democrat Cora Neumann warned against potential privacy infringements, expressing concern over legislators’ roles in healthcare decisions.
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