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Bullock admin seeks Medicaid-expansion expert – before expansion approved

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HELENA – A coalition of health care and business lobbies, state lawmakers and Gov. Steve Bullock’s office has been quietly discussing options to expand Medicaid in Montana, hoping to craft a compromise on the politically charged topic.

“I think there are a lot of folks trying to come up with a solution,” said Sen. Ed Buttrey, R-Great Falls, who’s part of the group. “The goals are cheaper cost, better (medical) service and a healthier population.

“If we can find a way to do it, we will; if we can’t, we can’t.”

Buttrey and others said the coalition would like to devise a Medicaid proposal to cover thousands more Montanans, to be enacted by the 2015 Legislature – or, even earlier, if the Legislature meets in special session this summer.

“Governor Bullock has made it clear that all options are on the table for getting this done, which is why he’s actively working with legislators, activists and other interested Montanans, to find the best path forward to expand Medicaid in Montana,” Bullock’s health policy adviser, Tara Veazey, said this week.

Medicaid, the state-federal program that provides mostly free medical coverage for the poor, has been a divisive political issue in Montana and the nation for the past year.

Under President Barack Obama’s health care overhaul, states can expand Medicaid to cover all citizens earning up to 138 percent of the federal poverty level – $16,100 a year, for a single person – and have the federal government cover most of the cost.

Yet two dozen states, including Montana, have rejected the expansion, because Republican governors or GOP-controlled legislatures opposed to the health-care overhaul refused to approve it.

Medicaid already covers more than 100,000 people in Montana, mostly the elderly in nursing homes, the disabled and low-income children and their parents.

Bullock supports Medicaid expansion, which would cover an additional 70,000 low-income yet able-bodied adults in Montana.

After the Montana Legislature, controlled by Republicans, rejected the expansion, the Montana Medical Association started putting together the loose coalition that’s studying the issue at non-publicized meetings.

“We wanted to start working early on before the next Legislature, to flesh out the data and answer some of the questions,” said Jean Branscum, executive vice president for the MMA, which represents physicians in the state. “We’re all working toward building a consensus prior to the next (legislative) session.”

The coalition includes the MMA, hospitals, some legislative leaders, the Montana Chamber of Commerce and the state’s largest private health insurers.

Yet the MMA and business leaders say they’re not supporting a “straight” Medicaid expansion in Montana, in which the state would offer direct, expanded coverage and administers the claims.

Instead, they want to use the federal Medicaid-expansion money to subsidize private health insurance for those earning less than 138 percent of the poverty level – a so-called “private option.”

Last week, coalition members met in Helena with Arkansas officials about that state’s Medicaid-expansion plan, which uses the private option.

The Arkansas officials, including the state’s Medicaid chief and a Republican state senator, also met separately with Bullock administration officials and legislative leaders from both parties.

“One of my goals was to get Arkansas folks in here and show just how conservative a plan it really is,” said Rep. Chuck Hunter, D-Helena, who helped organize the meetings.

Buttrey said the group also is looking at reforming the entire Medicaid system, to reduce medical costs, make it more efficient and create some accountability for patients covered by Medicaid.

Sen. Fred Thomas, R-Stevensville, who’s been working with a separate group of Republican legislators, said Republicans may be interested in a narrower plan that does not offer coverage to low-income citizens who are unemployed.

The governor’s office, however, said such a plan probably wouldn’t meet federal approval, because it doesn’t offer coverage to everyone under 138 percent of the poverty level.

Nonetheless, Thomas said he thinks his group and the coalition will strive to find some agreement on a proposal by the time the 2015 Legislature convenes next January.

“I suspect there will be a conference of these ideas brought together, with Republicans, Democrats, and health-care professionals coming together to find the common ground that creates a far better solution in health care than is being forced on us today from the federal government,” he said.

Missoulian State Bureau reporter Mike Dennison can be reached at 1-800-525-4920 or by email at

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