Medicaid expansion bill clears the House
Phil Drake, Great Falls Tribune
HELENA – A Medicaid expansion plan for Montana passed its third reading in the House on Saturday with a corrected fiscal note and is now moving on to the Senate where it will likely undergo further debate and perhaps more changes.
As it was a third reading there was no debate on the House floor.
The vote for House Bill 658 came after a marathon of meetings Friday that started at 8 a.m. and adjourned about 11 p.m. The lawmakers had second readings on 52 bills and third readings on 21 Friday, according to the legislative website.
Legislators were back on the floor at 9 a.m. Saturday and had second readings on nine bills and third readings for 21 bills. They adjourned at about 10:30 a.m.
Saturday’s vote on Medicaid expansion was 61-37. The current Medicaid expansion program, passed in 2015 and known as the Health and Economic Livelihood Partnership (HELP) Act, provides health care to 96,000 Montanans. It ends June 30, unless it is replaced with a new program.
Rep. Ed Buttrey, R-Great Falls, HB 658’s sponsor, spoke early at the Saturday session telling lawmakers a corrected fiscal note on their desks showed the program would be cheaper.
It estimates a net impact to the General Fund balance of $9.4 million a year, going to $13.7 million in 2021, $12.8 million in 2022 and $11.9 million in 2023.
According to the note, HB 658 creases a community engagement program for members.
HB 658, which has undergone 85 amendments, was hotly debated on the House floor Friday with some Republican lawmakers saying the bill was rushed, was not the original bill they had reviewed and was resoundingly opposed by their constituents.
Democrats had supported HB 425 by Rep. Mary Caferro, D-Helena, that failed and supported HB 658 so that those on Medicaid expansion would not lose their benefits.
According to the fiscal note, HB 658 includes increasing community engagement for members, higher fees for some, eliminating current patient co-pay and requires the Department of Labor and Industry to continue the HELP-Link work force development program and grant programs to encourage employers to hire or train Medicaid expansion participants.
The bill includes a work requirement of 80 hours a month of community engagement for those 19-55 years old. That could be work, work training, education and substance abuse treatment. It also requires Hutterite colonies to pay the state’s share of their members’ coverage costs.
The program would be supported by federal money and state money.
As of Feb. 1, there were 96,812 low-income Montanans on Medicaid expansion, the fiscal note states. Of those, there are now 88,019 people meeting community engagement requirements. The remaining 8,163 would have to participate in these activities to remain eligible. Of those, 4,081 will be unable to participate and be removed from the program.
An earlier fiscal note by the Governor’s Office of Budget and Program Planning had predicted that nearly 50 percent of the people now on Medicaid would be excluded on the new plan.
The bill includes a 2.75 percent tax on Montana State Fund workers compensation premiums to help fund the program. It includes a fee of slightly less than 1 percent of hospitals’ revenue for outpatient services to help support the program. In exchange, the hospitals will get a higher reimbursement rate for services to Medicaid recipients.
On Wednesday, a federal judge blocked a requirement by Arkansas that people on its Medicaid expansion program work or lose coverage. U.S. District Judge James E. Boasberg in Washington, D.C., found the requirements pose numerous obstacles to getting health care, the Associated Press reported.
Buttrey said Wednesday the Montana proposal would move forward as this is being resolved in litigation.
Rich Rasmussen, president of the Montana Hospital Association, commented on Saturday’s vote and said his organization was “heartened by the hard work toward a bipartisan solution to continue Medicaid expansion,” which he said has created more than 9,700 jobs, $793 million in associated wages and $2 billion in economic activity.
“It’s positioned our state to be a more desirable place to live, work and do business,” he said.
Also on Saturday, the House had a fiery debate over HB 653, a bill supported by Rep. Willis Curdy, D-Missoula, to revise the Montana Indoor Air Act and prohibit vaping in public places and worksites, but make an exception for schools in which it is used for certain educational purposes.
Rep. Sharon Stewart-Peregoy, D-Crow Nation, said lawmakers needed to think of the well-being of future generations and pass the bill.
“What we do here will impact a generation,” she said. “It will harm their health.”
One lawmaker said there are already bills in the system to deal with the issue. Another said the bill never had a fair hearing as opponents were not aware of a public hearing.
HB 653 failed 47-53.
Some lawmakers were a little worn from the night before and there were several instances of floor speeches Saturday in which they were confused as to whether they supported or opposed a bill.