A Tale of Two Medicaid Bills: With Very Different Endings

On Saturday, March 16, the House Committee on Human Services will hear two bills, both of which will continue Montana’s Medicaid expansion program, but handle the program moving forward in very different ways and will lead to very different results.

HB 425, sponsored by Rep. Caferro, will continue the successes of Medicaid expansion, which has expanded health care coverage to more than 96,000 Montanans, increased access to substance use disorder (SUD) treatment, and lowered the uninsured rate in the state. At the same time, workforce participation went up for populations with low-incomes, a trend not happening elsewhere in the country. In fact, over half of those employed after completing the HELP Link workforce training program had higher wages, with an average wage gain of $8,057 average over the previous year. Medicaid expansion is working, and HB 425 will continue those successes.

HB 658, sponsored by Rep. Buttrey, would have a much different effect. HB 658 would add new requirements for those on Medicaid expansion to report work activities at the risk of losing health insurance, often when it is needed most. HB 658 would require enrollees to report 80 hours per month of specific activities in order to keep their insurance. Compared to requirements proposed in other states, HB 658 exempts fewer individuals and will result in greater loss of coverage, including those that are likely already working, caring for family members, or facing serious barriers to employment. For example, unlike nearly every other state that has proposed similar reporting requirements, HB 658 would require those with mental health or substance use disorders to report 80 hours per month of activities, even while getting treatment. While the legislation technically exempts full-time students in college, this exemption is unlikely to apply to nearly all Montanans enrolled in colleges and universities in the state. For those who are caring for others, individuals are only exempt when caring for a child under the age of 7 or caring for a family member that is receiving disability benefits, leaving out thousands of parents and Montanans caring for other family members.

We have said time and time again – harsh reporting requirements will hurt those struggling the most to access work and health coverage. For the populations where we have some of the most positive benefits of expansion – rural communities, veterans, American Indians, and those with substance use or mental health disorders, all of whom desperately need access to health care coverage –will be hit the hardest by this bill.

HB 658 lock outs Montanans from the health care coverage for failing to navigate bureaucratic regulations. Not only do individuals have to complete reporting for work or other activities, but HB 658 also requires enrollees to fill out a health risk assessment and a work readiness assessment annually. On top of that, enrollees must report any permanent change of income within 10 days. While all of this may seem harmless, think about the confusion of filling multiple forms that seem very similar and have arbitrary deadlines.

Experts project that the harsh requirements embedded in HB 658 would result in roughly 40,000 Montanans to lose their health care coverage and will take Montana back to a time when people could not get coverage and families suffered. This is a bill that will cause thousands to fall through the cracks. Parents of young children caring for their kids while grappling with how to pay for child care. Montanans struggling with substance use disorders who have finally accessed critical treatment and now being asked to focus on bureaucratic reporting requirement. A worker caring for a family member with Alzheimer’s that now must also participate in certain activities. One mistake, and they lose protection against cancer or another serious illness. One missed deadline, and they lose access to drug treatment. One misstep, and any family’s nightmare turns into a reality.

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