State lawmakers discuss future of Medicaid expansion

Bozeman Daily Chronicle – September 11, 2017

With Montana’s Medicaid expansion due to sunset in 2019, lawmakers met here Monday to start reviewing the program that connects nearly 81,000 Montanans to health coverage.

The Children, Families, Health and Human Services Interim Committee met to talk about how the Medicaid expansion stands today and what funding changes could come down the road.

The meeting followed months of failed GOP efforts to wipe out the nation’s existing health care structure. The conversation also came on the heels of news that Montana will face further state budget cuts, including $105 million for the Department of Public Health and Human Services.

“It’s about the framework for health care going forward,” Caferro said.

The two structures the committee discussed were a per-capita cap and block-grant funding. Deborah Bachrach with Manatt Health said both of those options would limit Montana’s access to federal dollars.

“From my perspective, you’re turning over spending decisions and fiscal discipline to the federal government,” Bachrach said about the funding models.

She said under a per-capita model, if a state exceeded its federal spending, that money would come out of the next year’s allotment. Bachrach said as a result, the state may try to hold back spending, though any federal dollars that go untouched would never return to the state.

“I agree that being a cost-conscious consumer can drive you below your cap, but I would call that a positive,” said Sen. Al Olszewski, R-Kalispell.

Patti Jacques of Helena said she attended the meeting as the mom of a man who relies on Medicaid expansion dollars for stabilizing services.

“If we start dictating how much services my son’s going to get, and if we start eliminating those services through a Medicaid cap, it will be devastating,” Jacques said.

Lawmakers created the law known as the HELP Act in 2015. At the time, the Montana Budget and Policy Center projected the expansion would bring health coverage within reach of 5,315 uninsured adults in Gallatin County.

As of this summer, 5,299 had signed up. That represents nearly 5.5 percent of the county population. Close to 3,000 of those Gallatin enrollees were ages 18 to 34.

Monday’s meeting was the first in an effort to spend 16 hours over the interim reviewing the expansion in a buildup to lawmakers deciding whether to continue the program.

Sen. Eric Moore, R-Miles City, said he wanted to know whether people were rotating out of the Medicaid expansion.

“That’s a fairly significant policy question for us as a Legislature and state government to answer as to whether this is actually a step up, truly a HELP Act, or whether we’ve created just another entitlement program,” Moore said.

Sue O’Connell, a legislative committee researcher, said she hoped to work with the health department to find those numbers for the interim committee.

As for cost of the expansion, O’Connell said the federal government covered the entire program during its first three years. This year, Montana will pick up 5 percent of the tab.

O’Connell said the current biennium, which began in July, estimated Montana’s expansion will cost $1.1 billion. The state’s share of that could reach roughly $82.5 million.

However, she said budget cuts triggered by state revenues falling short of expectations will eliminate Montana’s contract with Blue Cross Blue Shield to offer the expansion program. That’s predicted to reduce general fund costs toward the expansion by $4 million.

O’Connell said in November, the committee is slated to review how the state has carried out the program.

In January, the interim committee intends to explore how the expansion’s workforce program is playing out. The program aims to help enrollees connect to better-paying jobs, an addition that helped gain the act enough Republican support to become law.

In March, health providers are schedule to talk with the committee about the impact they’ve felt from the expansion.

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