Montana governor says Medicaid expansion bill isn’t perfect, but gets his support
Holly Michels, Helena IR
Montana Gov. Steve Bullock said Monday he can support the Medicaid expansion bill that cleared the state House over the weekend, with the inclusion of work requirements.
“While it may not be perfect, perfect rarely comes out of this body, and we did a lot of work to try to make sure that we have something that will certainly work for Montana and work for Montanans,” said Bullock, a Democrat.
Even before lawmakers convened in Helena at the start of January, Republicans made clear that for enough of them to join Democrats in continuing the program, it needed some sort of work requirement component.
Bullock had been vocal in his opposition to work requirements, pointing to data showing most of those covered by expansion in Montana were already working, and highlighting studies showing thousands here would lose coverage under the provisions.
Republican Rep. Ed Buttrey, of Great Falls, is carrying the surviving bill to extend the Medicaid expansion in Montana. The program covers about 96,000 people and will sunset this summer unless lawmakers decide to continue it.
Medicaid expansion covers those earning up to 138 percent of the federal poverty level, or $17,236 for an individual and $29,435 for a family of three.
Democrats had a bill that would have continued the program much in its current form, but it was voted down in the House Human Services Committee last week.
Amendments to Buttrey’s bill, especially a change in how people report the hours they work to meet the requirements or show they’re exempted from them, were critical in swaying Bullock.
In addition to added exemptions to the work requirements, the bill changed last week to ease the reporting burden by allowing the state health department to use information it already has to determine if people are complying or exempt.
That greatly reduced the number of people expected to lose coverage under the work provisions, from up to 59,000 to just more than 4,000 expected to lose coverage.
Nearly 18,000 lost coverage in Arkansas after that state put work requirements into place last year. Many of those people were working, but unable to report their hours to the state as required.
“What we’ve seen in other states is bureaucratic barriers end up kicking off folks that shouldn’t be kicked off, so now what we’re doing, it’s limited to very defined group of folks and also has some safeguards if a lot more people are getting kicked off,” Bullock said.
Another amendment to Buttrey’s bill lifted a provision that would have ended expansion in Montana if work requirements were struck down by a court. That happened the day after the bill cleared a House committee, when a federal judge banned work requirements in Arkansas and Kentucky.
The new version says that if the U.S. Supreme Court finds work requirements unconstitutional, Montana’s expansion program would continue until 2025 without the provision. Kentucky’s case is expected to reach the high court.
Some Republicans who voted for expansion said that change essentially gives the program another sunset date. They also pointed to moving the money for funding the program into the budget process as another opportunity for lawmakers to review the program every two years.
Bullock said he feels confident that still gives those covered on expansion enough stability in their access to health care coverage. Since the start of the session, Democrats have pressed for longevity in the program to ease concerns from the nearly 10 percent of the state who get their health insurance through expansion.
“Everything that happens at the state Capitol, in some respects, has a two-year window of review. So from that perspective, no, I’m not concerned,” Bullock said. “ … Six years later if we need to take a look at that, we certainly could. I think that was a responsible accommodation by Democrats and Republicans.”
Other changes to the bill last week include tweaks to the asset testing, also called a taxpayer integrity fee. The fee has been a part of the program since it first passed in 2015.
Under the amendments, people who have $255,00 in equity in their home; more than one vehicle with a combined depreciated value of $20,000 and least $5,000 of equity in the vehicle or agricultural land with a taxable value of more than $1,500 a year, pay an additional $100 a month fee for expansion coverage.
They would also pay another $4 a month for each each $1,000 they’re over those dollar limits, except on the agricultural land; for that they would pay another $4 a month for each $100 they’re over the limit.
A fiscal note on the bill estimates that if these rules were in place in 2017, about 64 people would have fallen under them.
The new fiscal note also for the first time estimates the number of Hutterites covered on the program at 2,500. Hutterite colonies, which are organized as 501(d) organizations, would pay a fee based on the number of people they have covered on expansion that would generate about $1.5 million a year to offset the state’s share of the cost of the program.