Sue O’Connell
HELENA, Mont. — Despite issues about what Congress and the Trump administration might need deliberate for Medicaid, Montana’s Republican-led legislature and GOP governor seem able to preserve the state’s Medicaid growth program in place past its scheduled finish date this summer season.
State lawmakers don’t have the luxurious of ready till the federal image sharpens. They should determine earlier than the session ends in early May whether or not to carry a June 30 sundown date for the growth program, which covers about 76,000 adults.
However, the chance that vital adjustments lie forward for the joint federal-state Medicaid program has spurred dialogue of whether or not legislators ought to — or can — put together for what could also be coming. That’s the problem for lawmakers this session, stated Republican state Rep. Jane Gillette throughout a latest assembly of the price range subcommittee she chairs that works on the Medicaid price range.
“What are the different options we have for bracing ourselves for that?” Gillette stated.
The U.S. House is engaged on a price range invoice to replicate President Donald Trump’s priorities, together with allocating as much as $4.5 trillion to increase tax cuts that may in any other case expire.
A plan handed by the House Budget Committee on Feb. 13 requires $880 billion in cuts over the following 10 years for the committee that oversees, amongst different issues, Medicaid spending. Ideas reportedly beneath dialogue embody federal work necessities for some Medicaid enrollees and a lower within the share of prices the federal authorities pays for individuals coated by the growth program.
Some of the proposals would shift vital prices to the states, famous Robin Rudowitz, a vice chairman and the director of the Program on Medicaid and the Uninsured at KFF, a well being info nonprofit that features KFF Health News. If that occurs, states might want to elevate income or lower spending elsewhere to proceed the identical stage of Medicaid protection, she stated.
There are “no easy answers or options for states in these scenarios,” she stated.
Some states are debating find out how to put together for doable federal adjustments. The South Dakota Legislature is considering a bill that may ask voters whether or not to proceed Medicaid growth if the federal share drops. A bill to repeal Idaho’s expansion program outright has been launched however not heard, whereas another making it contingent on federal approval of a number of limitations passed the state House on Feb. 19. Montana and eight different states have trigger laws that might finish their growth packages if the federal contribution price drops.
The GOP-controlled Montana House of Representatives simply handed a invoice to make the Medicaid growth program everlasting on Feb. 10 by a 63-37 vote. Then on Feb. 20, House Bill 245 handed the primary of two votes required for Senate approval. Gov. Greg Gianforte has not publicly stated whether or not he would signal the invoice, however he beforehand stated he believes the growth program ought to proceed if robust work necessities are in place.
In late January, the price range subcommittee that Gillette chairs was reviewing Medicaid growth’s monetary implications when discuss shortly turned to the doable federal adjustments, notably a drop within the federal matching price.
Republican state Sen. Carl Glimm famous that observers have known as a decrease federal matching price “pretty low-hanging fruit.” The change would require congressional motion, although, and members famous that might take time.
The federal authorities pays 90% of the well being care prices of growth enrollees. That group is made up of adults ages 19 to 64 with out disabilities and who’ve annual incomes at or beneath 138% of the federal poverty stage, or $21,597 for a person.
Until the federal Affordable Care Act allowed states to increase Medicaid to this group, this system was usually restricted to low-income kids, pregnant girls, and adults who’re blind, disabled, or at the least 65. The federal match for these teams in Montana might be about 62% within the subsequent state fiscal 12 months, which begins in July.
The state spent practically $1 billion on Medicaid growth in 2024, with its share of the prices totaling slightly below $100 million. Budget committee employees stated a ten% discount within the federal share would add roughly $100 million in state prices. If the state’s share goes from 10% to the common state match of 38%, the state would pay about $280 million extra a 12 months for growth.
Subcommittee member Russ Tempel, a Republican senator, famous that the federal share modified previously on account of sudden occasions, akin to covid-19.
“Something’s going to happen that’s unpredictable,” he stated. “It’s happened before, and it’s going to happen again, so we’re kind of a little bit shooting in the dark.”
But Republican Sen. Jeremy Trebas targeted on the possible federal adjustments when urging senators to assist his invoice to tighten the work necessities in present legislation and, if federal approval had been denied, ultimately finish this system.
“We should match up our state policy to coming federal policy so that we’re not caught off guard and expectations aren’t radically altered by what the federal government does,” he stated throughout a committee listening to on Senate Bill 199.
The invoice died final week on the Senate flooring when all Democrats voted towards it, together with a block of 9 Republicans who’ve damaged with their get together on different points this session. Roughly the identical coalition additionally killed a invoice by Glimm that may have phased out the growth.
Trebas stated just lately he expects HB 245 to cross but in addition believes that federal Medicaid adjustments might occur extra shortly than some assume doable, forcing a particular Montana legislative session to regulate to these adjustments.
Gillette, who voted towards HB 245, stated in a latest interview that the legislature ought to present the Gianforte administration with a spread of choices to permit it to “course correct” with out additional legislative involvement if Medicaid growth continues and federal adjustments come down earlier than the legislature meets once more in 2027.
State Senate President Matt Regier introduced a bill Feb. 15 to restrict the growth inhabitants to individuals beneath 100% of the federal poverty stage and to provide the state well being company the flexibility to restrict spending or enhance program integrity.
Regier’s invoice additionally would make the growth program contingent on the federal authorities approving a “community engagement” waiver, which incorporates work necessities, and it requires lawmakers to vote on whether or not to carry a particular session if the federal Medicaid matching price drops greater than three months earlier than the following common session.
But HB 245 sponsor Rep. Ed Buttrey, one other Republican, stated in a latest interview that existing law takes care of any future lower in federal assist by requiring both the state to extend premiums for this system or the legislature to acceptable extra funds if this system is to proceed.
Buttrey additionally stated the legislature can’t make choices now primarily based on what federal legislation could be sooner or later. He stated it’s unlikely that federal Medicaid coverage would change shortly, however that if it did, this system impacts such a big proportion of the state’s inhabitants {that a} particular session could be warranted.
“I can’t think of one that’s more important than that,” he stated.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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