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Medicaid Expansion

Democratic Gov. Steve Bullock, center, signs a bill to expand Medicaid to about 70,000 low-income Montanans on April 29 at the state Capitol in Helena.

Nearly 70 Republican state lawmakers want Montana to have a work requirement for people who qualify for Medicaid under its expanded program.

Earlier this year, at the urging of the White House, the federal Centers for Medicare and Medicaid issued guidance that would let states apply for waivers that require people to work to be eligible for Medicaid coverage.

The Trump administration and some conservatives have long advocated for Medicaid work requirements, saying "able-bodied" people should be working for the benefits they receive. Opponents argue it will take away health care coverage, which is often a step toward steady employment, from people who need it most.

Medicaid expansion extends Medicaid coverage to people earning up to 138 percent of the federal poverty level: $16,700 annually for a single person or $34,600 for a family of four. 

A person working 40 hours a week earning Montana's minimum wage earns $17,264 annually.

Montana passed its expansion in 2015. More than 96,600 adults have enrolled in expansion since 2016.

Sixty-seven state lawmakers, all Republicans, signed a letter asking Gov. Steve Bullock, a Democrat, to apply for a waiver to let Montana implement the work requirement.

“We want to help encourage those in the Medicaid system who can work to get the job training and resources needed to do so,” said Senate Majority Leader Fred Thomas, R-Stevensville. Medicaid expansion "is intended as a short-term tool to help with health care costs, and strengthening work and volunteer requirements will reduce dependence and allow resources to be directed to those who need them most.”

The letter says "able-bodied adults" should be required to work, train or volunteer for at least 20 hours a week. People would be exempt if they were under the age of 19, older than 64, pregnant or a caretaker for a child or someone who has a serious medical condition or disability. Those in drug or alcohol treatment, as well as people medically certified as physically or mentally unfit for employment, would also be exempt. 

Arkansas, Indiana and New Hampshire have imposed work requirements. Seven other states -- including Alaska, Arizona, Kansas, Maine, Michigan, Mississippi, Ohio, South Dakota, Utah and Wisconsin -- are seeking waivers, according to the Kaiser Family Foundation. Kentucky's waiver was rejected by a federal district court and is being revised.

Bullock said Tuesday that Montana should instead focus on its one-of-a-kind voluntary workforce program, called HELP-Link, that legislators created when expanding Medicaid.

“What Sen. Thomas is suggesting has already been struck down by the courts and costs more to administer than it does to provide services in the first place,” Bullock said. “Montana has a national model that other states are looking to and that is actually putting people to work. We ought to build on Montana’s successes instead of spending millions on a scheme that doesn’t pass muster.”

A little more than 2 percent of those covered under expansion, or 2,500 people, have had intensive one-on-one work counseling, according to numbers from the state Department of Labor and Industry compiled by Manatt Health in a report commissioned by the Montana Healthcare Foundation this summer.

About 22,000 people, either already employed or not, received some form of employment services.

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The report also showed many people covered under Medicaid expansion already had jobs or were working. Just over 81 percent lived in families where at least one adult was working; 67 percent were working themselves.

Another study, conducted by the Bureau of Economic Research at the University of Montana for the Montana Healthcare Foundation, found labor force participation among Montanans eligible for Medicaid expansion coverage rose 8.5 percent since expansion while it dropped 2.5 percent nationally.

That report did not draw any conclusions as to the cause of the increase here, but said the result was "consistent with the hypothesis that Medicaid expansion and Montana's HELP-Link program improved employment outcomes for Montana's Medicaid expansion beneficiaries.''

Bullock’s office said an application for a waiver would require legislative approval and added federal funds may not be used to implement work requirements.

Medicaid expansion pays for benefits at a higher rate than regular Medicaid. While the share the federal government picks up tapers down to 90 percent by 2022, it’s still higher than the roughly 65 percent paid by traditional Medicaid.

Voters this November will also see a ballot initiative to increase the tobacco tax and use the revenue to pay for the state’s share of Medicaid expansion. If passed, the initiative would make expansion permanent. If it does not pass, the Legislature can choose to extend, alter or let expansion sunset in the summer of 2019.

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State Bureau reporter for The Independent Record.

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