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House committee endorses heavily amended Medicaid bill

March 27, 2019

HELENA, Mont. (AP) — A House committee on Tuesday endorsed a heavily amended bill to continue Montana’s Medicaid expansion program with a work requirement.

Republican Rep. Ed Buttrey said the amendments he proposed addressed many concerns expressed by those who testified against his bill during a daylong hearing on March 16, along with concerns by both parties and the state Department of Public Health and Human Services, while still meeting his goal of having work requirements and an improved asset test.

Legislative lawyers questioned the constitutionality of a provision requiring Hutterite colonies to pay the state’s share of Medicaid expansion cost for their members. Buttrey did not change that provision, saying the colonies support it.

The House Human Services Committee first took up a bill by Democratic Rep. Mary Caferro to keep the health care program that covers 96,000 low-income Montana residents largely intact. After it was amended to add a work requirement and a sunset date, Democrats moved to table it.

Buttrey proposed amendments to his bill to address concerns that his program was setting up a costly bureaucracy with requirements to report work or community engagement hours that would cause people to lose their coverage. The amended bill would require an audit if more than 5 percent of participants are suspended from the program for not meeting reporting requirements. If more than 10 percent of those suspended are found to have been wrongly suspended, further suspensions would end until the next legislative session.

He also amended the bill to:

— Exempt people older than 55 from work requirements, down from age 59

— Continue a premium increase from 2 percent of a person’s income after two years of coverage, but with a cap of 4 percent, down from 5 percent in his initial bill

— Add a sunset in six years to require another look after an expected U.S. Supreme Court decision on work requirements

Rather than requiring everyone to complete a health risk analysis, as his initial bill did, Buttrey proposed that within a year of enrollment the state health department assess whether the insured would be better served by having coordinated care, a case manager or treatment for substance abuse or mental health.

His initial bill would have ended the Medicaid expansion program in Montana entirely if the U.S. Centers for Medicare and Medicaid Services rejected the work and community engagement requirement. He removed that provision.

Lawmakers approved Buttrey’s amendment 14-5, but some Republicans questioned whether they needed more public input and an updated fiscal note.

“Now we have this amendment and not only do we not have time to process it, but neither does our public or constituents,” said Republican Rep. Barry Usher. “I usually oppose this kind of thing and I am going to oppose it now.”

Rep. Kim Abbott said she and fellow Democrats would support Buttrey’s bill, as amended, although she noted the work requirement was a significant compromise.

Buttrey’s bill passed 11-8.

Conservative Republicans oppose both bills, saying funding for the program is not sustainable because of federal deficit spending.