Medicaid Expansion

Medicaid expansion was a major initiative of Gov. Steve Bullock during the 2013 Montana Legislature, but Republican lawmakers rejected the proposal.

HELENA – As promised, Gov. Steve Bullock on Monday unveiled his plan to make another run at asking the Legislature to accept millions in federal dollars to provide health coverage for 70,000 low-income Montanans.

The governor’s plan, revealed as part of his proposed two-year budget, would accept federal money to expand Medicaid, the state-federal program that pays medical bills for the poor.

Legislative Republicans rejected a Medicaid-expansion proposal in 2013, arguing the state couldn’t afford it and that they didn’t want to implement part of the Affordable Care Act, or "Obamacare,” the 2010 federal health care law.

Bullock, a Democrat, said his new plan is a unique proposal for expanding Medicaid. It would use federal money to contract with a private administrator to process claims and run a network of physicians, hospitals and other providers to serve the newly covered population, he said.

“Montanans want a health care system so that (they) don’t have to live in fear, of not being able to provide for themselves and their families,” Bullock said. “I look forward to working with the 2015 Legislature to assure we achieve these goals. ...

“This is more or less a new way than any other state has taken.”

But a Republican state senator who’s worked on health care issues said Monday he doubts many Republicans would support Bullock’s proposal.

“It sounds like Medicaid expansion, in general,” said Sen. Fred Thomas, R-Stevensville. “Our priorities are not there at all."

Thomas, part of a working group of Republicans examining health care, said the party is more interested in ensuring Medicaid fully takes care of the population it currently covers in Montana: disabled adults, low-income senior citizens and children.

“To expand Medicaid to childless, able-bodied adults just doesn’t make sense,” he said. “You’re taking precious public dollars and diverting them into an area that is not the priority.”

Under the 2010 Affordable Care Act, states can choose to expand Medicaid to cover everyone earning up to 138 percent of the federal poverty level, or $16,100 for a single person and $27,300 for a family of three.

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The feds pay all of the expansion costs through 2016, after which the federal share gradually declines to 90 percent by 2020. However, legislatures must approve any expansion in their respective state.

Bullock proposed Monday to accept the federal money starting next year.

Everyone newly eligible for the coverage – estimated at 70,000 people – would fall under a plan managed by a private administrator, such as an insurance company.

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Bullock said the plan also could include “innovative” programs, such as disease management and care coordination that focus on treating and controlling chronic illnesses, such as diabetes.

State health officials said the plan will save the state money over the next two years because it will reduce state spending on uninsured people with mental health needs and create a higher federal match for newly covered people through 2019.

However, the new plan also would need approval from federal health officials. Bullock said initial discussions with the feds about the plan have been encouraging.

House Minority Leader Chuck Hunter, D-Helena, who sponsored a Medicaid expansion bill in 2013, said Monday he likes Bullock’s proposal.

“We’re allowing some private management, (but) it doesn’t turn over everything to the private insurers to manage,” he said.

Hunter said he expects the Medicaid proposal faces “the same uphill battle this issue faced last session,” particularly because Republicans appear likely to oppose major proposals coming from the Democratic governor.

Two key health care lobbies – the Montana Medical Association and MHA, which represents hospitals – didn’t come out directly in favor of Bullock’s plan. But both groups said they’re happy to see a proposal that could expand access to health care.

“He’s tossed something on the table for people to consider, and we think that’s a good thing,” said Jean Branscum of the MMA.

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