A pivotal Montana Medicaid expansion bill advanced in the state House, marking a crucial step for a high-stakes policy. Sponsored by Rep. Ed Buttrey, R-Great Falls, the legislation aims to extend Medicaid beyond 2025, currently covering about 75,000 low-income adults. This state-federal initiative, active since 2015, survived a previous end date in 2019 thanks to bipartisan support.
House Bill 245, backed by 63 lawmakers across both parties, faces opposition from 37 Republicans. It represents the first Medicaid proposal discussed by the full Legislature this session. A contrasting Senate bill seeks to phase out the program by halting new enrollments post-September. Another effort to sustain expansion, led by Rep. Mary Caferro, D-Helena, was tabled in committee earlier.
Advocates highlight Medicaid’s role as a health care and economic lifeline, with a state report indicating over 20,000 businesses employed workers with Medicaid coverage in 2023. “These businesses are the backbone of every Montana community,” Buttrey emphasized. Rep. Donavon Hawk, D-Butte, shared how Medicaid enabled him to adopt family members.
Opponents question Medicaid’s $1 billion annual cost, largely federally funded, which could strain Montana’s finances if altered. “If the match isn’t 90-10…it is a financial burden,” warned Rep. Bill Mercer, R-Billings. Buttrey noted existing safeguards, where state action or increased premiums would offset any federal funding drop.
The debate extended to Medicaid’s impact on rural hospitals and health systems. Beneficiaries include major industry groups like the Montana Chamber of Commerce. Nevertheless, Rep. Jane Gillette, R-Three Forks, argued for reallocating funds to more effectively aid rural health providers and combat poverty. “This is not your only bite at the apple,” she stated.
Competing amendments sought to mandate a waiver resubmission to federal health authorities and shift the bill to House Appropriations, but both failed. The bill awaits one more House vote before moving to the Senate.
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