Missoula, MT — Montana’s Medicaid expansion program, which provides healthcare to low-income individuals, is one step closer to becoming permanent after the passage of House Bill 245 (HB 245) in the state Legislature. The bill, which removes the sunset date for the program, passed its final vote in the Senate on Thursday, signaling a potential end to months of legislative debate on the issue. The bill now awaits approval from the governor, but discussions around Medicaid expansion are far from over.
Rep. Ed Buttrey (R-Great Falls), who sponsored the bill, expressed satisfaction at the speed with which it passed. “I think it’s nice to get it done before transmittal and to know that there were enough representatives and senators that understood the benefits that the program’s providing to our citizens and to our businesses,” Buttrey said. The legislation’s passage is notable, given that Medicaid expansion had been expected to be a significant issue throughout the 69th legislative session.
Despite HB 245’s success, concerns about the future of Medicaid expansion persist. Opponents of the program’s extension argue that potential cuts in federal funding for Medicaid could strain the state budget. Currently, the federal government covers 90% of Medicaid expansion costs, but some lawmakers fear that any reduction in this support could force Montana lawmakers to return for a special session to address the fiscal impact.
The possibility of cuts to Medicaid funding has been raised in national media, particularly with reports suggesting that a House Republican budget resolution could demand substantial spending cuts, potentially affecting programs like Medicaid. Buttrey acknowledged these concerns but emphasized that Montana’s Legislature must plan based on the current structure of the program.
“I’m not so sure it’s going to be as easy as some of these folks may think to have Congress go back to their states and say, ‘Look, we’re either going to knock a whole lot of people, low-income working folks, off of coverage, or we’re going to have to tax our taxpayers even more to continue the program,’” Buttrey said. “If we do have to come back for a special session, this is a program that affects 76,000 to 80,000 Montanans. That is a reason to come back and have the debate.”
Members of Montana’s congressional delegation, including Republican U.S. Representatives Ryan Zinke and Troy Downing, have weighed in on the future of the program. Zinke advocated for improving efficiencies within Medicaid, focusing on eliminating fraud and waste. “There’s not one case of fraud in a $7 trillion program?” he remarked, calling for stronger oversight. Downing, meanwhile, expressed frustration over the federal government’s refusal to grant Montana a waiver to implement “community engagement” requirements. These requirements, if approved, would mandate that Medicaid expansion recipients spend 80 hours per month on work, education, or other approved activities.
Rep. Buttrey, however, argued that implementing work requirements may require Congressional action due to federal court rulings. He emphasized that the current design of Medicaid expansion was intended as an economic development tool, aimed at encouraging people to enter the workforce. “The vast majority of them do work or caretake or are in school,” Buttrey said. “The implementation of those work requirements isn’t punitive to our program.”
In addition to HB 245, lawmakers are considering other bills related to Medicaid expansion. House Bill 687, sponsored by Rep. Bill Mercer (R-Billings), would extend community engagement requirements to Medicaid recipients up to age 62. Currently, individuals over the age of 55 are exempt from these requirements. Mercer argued that it is inappropriate to exempt older participants from these requirements, pointing out that many individuals over 62 are still working and contributing to their communities.
Meanwhile, Rep. SJ Howell (D-Missoula) introduced House Bill 601, which would establish an online portal to assist individuals with Medicaid applications and eligibility redeterminations. Howell cited numerous complaints from constituents during the 2023 and 2024 eligibility reviews, noting that many people had difficulty navigating the process without adequate support.
As these bills continue to make their way through the Legislature, the future of Medicaid expansion in Montana remains a key issue. With HB 245 on the verge of becoming law, lawmakers are likely to continue debating both the long-term sustainability of the program and the potential changes that could affect the state’s low-income residents.
The outcome of this ongoing debate will not only shape the future of healthcare in Montana but also serve as a bellwether for the broader national conversation surrounding Medicaid and healthcare reform.
