Montana About to Consider Medicaid Bill Eliminating Coverage for Thousands

Update, March 15:  We’ve updated this post.

Montana lawmakers will hear testimony on two bills this Saturday: one would permanently extend the state’s successful Medicaid expansion under the Affordable Care Act beyond its June expiration, which would let Montana keep receiving federal funds to cover over 96,000 low-income adults; the other would also permanently extend the expansion but would take coverage away from adults who don’t meet a work requirement.

The latest Buttrey proposal would likely cause coverage losses similar to those in Arkansas, the first state to implement a Medicaid work requirement. Arkansas ended coverage for more than 18,000 people — or about 23 percent of those subject to the work requirement — in the first seven months it was in effect. That’s a much larger group than the policy’s supposed target population (namely, beneficiaries who aren’t already working or exempt from the requirement), which shows that many people who should still be eligible for Medicaid are losing coverage. As in Arkansas, most Montana Medicaid beneficiaries either work or should qualify for exemptions from work requirements. But they would still risk losing coverage if they couldn’t overcome the additional paperwork and red tape, couldn’t meet and report the required number of work hours each month, or didn’t fully understand the new requirements.

Medicaid work requirements simply can’t be fixed. The revisions to the Buttrey bill don’t change the fact that it would likely cause tens of thousands of Montanans to lose coverage. Along with its punitive work requirement, the bill would:

• Raise premiums to up to 5 percent of a family’s income and take coverage away from those who don’t pay premiums if their incomes are above the poverty line (roughly $21,000 for a family of three).
• Lock people out of Medicaid coverage for six months if they don’t meet the work requirement or don’t report a change in their circumstances, such as an increase in income.
• Lock people out of Medicaid coverage for six months if they don’t submit extra paperwork related to their job readiness and health status.

The bill also states that if a court strikes down — or the federal Centers for Medicare & Medicaid Services rejects — any of its provisions, the entire bill is void, including the provision empowering the governor to provide coverage through the Medicaid expansion. Given the serious legal challenges to work requirements in Kentucky and Arkansas, this provision jeopardizes Montana’s entire Medicaid expansion, which covers over 96,000 people.

A coalition of Montana health providers and business leaders have urged legislators “to continue Medicaid expansion without imposing unreasonable barriers to coverage.” They wrote, “Without health insurance, Montanans are more likely to seek the wrong care, at the wrong time and at the wrong place — with poorer outcomes and higher costs. . . . Coverage is the keystone to improving the health of our residents, increasing the efficiency of our health care system and decreasing costs for consumers, businesses and the state.”

Interestingly, Montana itself has a promising alternative to Medicaid work requirements. In fact, its workforce promotion program — HELP-Link, which provides Medicaid expansion beneficiaries with employment and training services — is a national model. Since its start in 2016, 25,000 expansion enrollees have enrolled in workforce training through Montana’s Department of Labor and Industry, the state says; 70 percent have found jobs within a year, according to the state.

HELP-Link offers a striking contrast to Arkansas’ policy of taking Medicaid coverage away from people who don’t meet harsh work requirements. If Montana lawmakers want to help low-income adults find jobs and advance their careers, they should expand HELP-Link, not reduce low-income Montanans’ access to health coverage.