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The fate of a proposal for the state to provide health coverage for 70,000 low-income people rests with legislators after Gov. Steve Bullock vowed to ask the Montana Legislature to accept federal money to expand Medicaid.

The governor’s plan needs approval by federal health officials and state legislators. Republicans voted down an expansion last year.

Whether the House and Senate will back the new plan remains to be seen, but area legislators and civic leaders are already rallying support for using federal funds to expand the Medicaid program or offer private insurance coverage

“There’ll be some type of Medicaid expansion,” said Jim Ahrens, a lobbyist with Alliance for a Healthy Montana at a forum held Tuesday at St. Peter’s Hospital Education Center. “… But conservative legislators will not pass a full government expansion,”

Expansion means $5.4 billion of federal funds to the state’s economy in the next six years and an estimated 12,000 new jobs, according to the nonprofit Montana Budget and Policy Center. People earning less than 138 percent of the federal poverty line would qualify -- $16,000 for a single person; $27,000 for a family of three.

The federal government would pay all of the expansion costs until 2016, and then reduce its share, but never pay less than 90 percent, said Claudia Clifford, advocacy director for AARP and a MBPC board member.

“I think the gains of covering of citizens outweigh concerns about federal funding,” said Erin McGowan, a lobbyist with Alliance for a Healthy Montana, before a filled conference room. The alliance consists of health-care providers, consumers and patient advocacy organizations who have attempted to pass public policy.

Enhancing access to care for low-income Montanans is one of the coalition’s priorities for the upcoming legislative session. Area officials supported the alliance’s legislative agenda. Lewis and Clark City-County Health Officer Melanie Reynolds said something must be done since 6,300 people remain uninsured in the county alone.

“Citizens are not getting preventative care,” she said.

Democratic state Sen. Cristine Kaufmann, Sen.-elect Jill Cohenour and Rep.-elects Mary Ann Dunwell and Janet Ellis offered support for the Democratic governor’s plan to ensure health care for citizens residing in their local districts.

“We will have more of a revenue balance each year that will offset any federal loss,” said Kaufmann, who added that the plan saves the state money over the next two years.

Citizens throughout the state must tell their legislators “at home” to support the plan and “have them be held accountable,” Cohenour said. “We have to embarrass them into doing what’s right.”

Mental health issues

Health forum participants discussed other priorities for the legislative session, but focused primarily on mental health issues plaguing the county and state.

“We have a long list of kids to treat, but we have trouble getting staff,” said Jack Casey, administrator at Shodair Children’s Hospital. The hospital is the only facility in the state of Montana to offer both acute and residential psychiatric treatment services for children and adolescents.

Shodair needs one primary therapist and eight nurses to accommodate a growing number of patients. Hospital administration wants an outpatient facility, but hasn’t started one due to the lack of staff, Casey said. One problem is the hospital competes nationally for workforce, but the state not reimbursing tuition often turns professionals elsewhere.

The overcrowded Lewis and Clark County Detention Center has also become a mental health concern for law enforcement.

“We have people sleeping in the libraries and hallways,” said Brett Friede, a training sergeant at the sheriff’s office. The facility has only two separate rooms to isolate inmates suffering from mental health issues and often fights, assaults and threats of suicide occur when those inmates are pushed into the larger population. “It’s amazing what we do because we have to. It sure isn’t what we need.”

Supporters of expanding Medicaid and the bills asking for additional funds toward mental health, among other initiatives, voiced concern legislators would vote down proposals due to the sheer amount of health needs expected to flood the Capitol.

“It really scares me,” said Kari Fairbrother, a registered nurse at St. Peter’s Hospital. “We better challenge our legislators. We better prioritize and narrow down our vital messages so we don’t overwhelm them.”

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