HELENA, Mont. — Regardless of issues about what Congress and the Trump administration may need deliberate for Medicaid, Montana’s Republican-led legislature and GOP governor seem able to hold the state’s Medicaid enlargement program in place past its scheduled finish date this summer time.
State lawmakers don’t have the posh of ready till the federal image sharpens. They need to determine earlier than the session ends in early Might whether or not to elevate a June 30 sundown date for the enlargement program, which covers about 76,000 adults.
Nonetheless, the chance that important modifications 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, mentioned Republican state Rep. Jane Gillette throughout a latest assembly of the finances subcommittee she chairs that works on the Medicaid finances.
“What are the completely different choices we’ve for bracing ourselves for that?” Gillette mentioned.
The U.S. Home is engaged on a finances invoice to mirror President Donald Trump’s priorities, together with allocating as much as $4.5 trillion to increase tax cuts that will in any other case expire.
A plan handed by the Home Finances Committee on Feb. 13 requires $880 billion in cuts over the subsequent 10 years for the committee that oversees, amongst different issues, Medicaid spending. Concepts reportedly below dialogue embrace federal work necessities for some Medicaid enrollees and a lower within the share of prices the federal authorities pays for individuals coated by the enlargement program.
A number of the proposals would shift important 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 Well being Information. If that occurs, states might want to elevate income or lower spending elsewhere to proceed the identical degree of Medicaid protection, she mentioned.
There are “no simple solutions or choices for states in these eventualities,” she mentioned.
Some states are debating put together for potential federal modifications. The South Dakota Legislature is contemplating a invoice that will ask voters whether or not to proceed Medicaid enlargement if the federal share drops. A invoice to repeal Idaho’s enlargement program outright has been launched however not heard, whereas one other making it contingent on federal approval of a number of limitations handed the state Home on Feb. 19. Montana and eight different states have set off legal guidelines that would finish their enlargement applications if the federal contribution charge drops.
The GOP-controlled Montana Home of Representatives simply handed a invoice to make the Medicaid enlargement program everlasting on Feb. 10 by a 63-37 vote. Then on Feb. 20, Home Invoice 245 handed the primary of two votes required for Senate approval. Gov. Greg Gianforte has not publicly mentioned whether or not he would signal the invoice, however he beforehand mentioned he believes the enlargement program ought to proceed if sturdy work necessities are in place.
In late January, the finances subcommittee that Gillette chairs was reviewing Medicaid enlargement’s monetary implications when speak rapidly turned to the potential federal modifications, significantly a drop within the federal matching charge.
Republican state Sen. Carl Glimm famous that observers have referred to as a decrease federal matching charge “fairly low-hanging fruit.” The change would require congressional motion, although, and members famous that would take time.
The federal authorities pays 90% of the well being care prices of enlargement 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 degree, or $21,597 for a person.
Till the federal Reasonably priced Care Act allowed states to increase Medicaid to this group, this system was typically restricted to low-income kids, pregnant ladies, and adults who’re blind, disabled, or not less than 65. The federal match for these teams in Montana will likely be about 62% within the subsequent state fiscal yr, which begins in July.
The state spent practically $1 billion on Medicaid enlargement in 2024, with its share of the prices totaling slightly below $100 million. Finances committee employees mentioned 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 yr for enlargement.
Subcommittee member Russ Tempel, a Republican senator, famous that the federal share modified previously resulting from surprising occasions, equivalent to covid-19.
“One thing’s going to occur that’s unpredictable,” he mentioned. “It’s occurred earlier than, and it’s going to occur once more, so we’re form of slightly bit taking pictures at nighttime.”
However Republican Sen. Jeremy Trebas centered on the possible federal modifications when urging senators to help his invoice to tighten the work necessities in present regulation and, if federal approval have been denied, finally finish this system.
“We must always match up our state coverage to coming federal coverage in order that we’re not caught off guard and expectations aren’t radically altered by what the federal authorities does,” he mentioned throughout a committee listening to on Senate Invoice 199.
The invoice died final week on the Senate ground when all Democrats voted in opposition to it, together with a block of 9 Republicans who’ve damaged with their occasion on different points this session. Roughly the identical coalition additionally killed a invoice by Glimm that will have phased out the enlargement.
Trebas mentioned not too long ago he expects HB 245 to cross but in addition believes that federal Medicaid modifications might occur extra rapidly than some assume potential, forcing a particular Montana legislative session to regulate to these modifications.
Gillette, who voted in opposition to HB 245, mentioned in a latest interview that the legislature ought to present the Gianforte administration with a spread of choices to permit it to “course right” with out additional legislative involvement if Medicaid enlargement continues and federal modifications come down earlier than the legislature meets once more in 2027.
State Senate President Matt Regier launched a invoice Feb. 15 to restrict the enlargement inhabitants to individuals beneath 100% of the federal poverty degree and to present the state well being company the power to restrict spending or enhance program integrity.
Regier’s invoice additionally would make the enlargement program contingent on the federal authorities approving a “group 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 charge drops greater than three months earlier than the subsequent common session.
However HB 245 sponsor Rep. Ed Buttrey, one other Republican, mentioned in a latest interview that present regulation takes care of any future lower in federal help 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 mentioned the legislature can’t make selections now based mostly on what federal regulation could be sooner or later. He mentioned it’s unlikely that federal Medicaid coverage would change rapidly, however that if it did, this system impacts such a big share of the state’s inhabitants {that a} particular session can be warranted.
“I can’t consider one which’s extra essential than that,” he mentioned.
