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Medicaid Expansion Montana

Democratic Rep. Mary Caferro, left, and Republican Rep. Ed Buttrey, right, watch Gov. Steve Bullock sign a bill to continue Montana's Medicaid expansion program in May in Helena. Buttrey sponsored the bill that includes a work requirement, an improved asset test and increased premiums for people who remain on the program for more than a year. 

BILLINGS — The head of the state health department emphasized Thursday that work requirements in the state Medicaid expansion program will not be implemented by January, but said they are on track with a timeline set by the department.

Medicaid expansion covers those earning up to 138% of the federal poverty level, $17,236 for an individual and $29,435 for a family of three.

Work requirements generally call for 80 hours of work a month, with exemptions for several groups of people such as pregnant women, those in school and others.

The law calls for work requirements to be implemented by January 2020, though it clarifies that the timeline is also dependent on federal approval of a waiver to operate the Medicaid expansion program and add work requirements.

The law gave the health department until Aug. 30 to apply for the waiver, which is the day they submitted their application to the federal Centers for Medicare and Medicaid Services (CMS). The law also says the department must notify people enrolled on expansion about when work requirements go into place.

Sheila Hogan, the director of the state Department of Public Health and Human Services, said Thursday the agency and governor's office have gotten calls from people concerned work requirements would go into effect in a month and a half, and that they hadn't been contacted.

"We are not delaying Medicaid expansion. We are not delaying work requirements. People are calling, asking 'When do I do my work requirements?''" Hogan told an interim legislative committee. "This will all take time. We are working the timeline. We are on the right track."

When Montana initially expanded Medicaid in 2015, the state submitted its waiver application Sept. 15 of that year. It was approved by Nov. 2, 2015.

This cycle, the federal Centers for Medicare and Medicaid held a comment period on the state's waiver application that ended Oct. 12. Many of the comments submitted were in opposition to the requirements, which are already in state law.

Hogan indicated that the addition of work requirements, and the legal challenges to similar proposals in other states, could make the waiver process more complex this time.

"We do know that work requirements have been thrown out in other states, so they are looking very closely at those. But we will do that back-and-forth work; that's the next step," Hogan said. "We are not behind, we are following the schedule and we'll know more in January."

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Three states have seen lawsuits filed challenging work requirements: Arkansas, Kentucky and New Hampshire. 

State Rep. Mary Caferro, who carried a competing Medicaid expansion bill earlier this year that did not include work requirements, asked Hogan on Thursday if the back-and-forth process between CMS and the state could take up to a year.

Hogan said she didn't know and was uncomfortable with wading into the hypothetical.

"I think we have a really solid plan. I'm sure they will look at our work proposal with a critical eye. There will be IT (work), all of those kinds of things," Hogan said. "It's the back-and-forth that I don't know what it will look like, but we're on track."

When the bill was drafted, the state said it would do as much as possible using data it already collects to validate the hours people work or any exemptions people would have to work requirements.

That is meant to help keep the number of people who lose coverage because of problems with reporting hours worked to a minimum. And back in July and August when the state held listening sessions on its waiver application, it made clear that it would not do extensive legwork to develop those systems until the waiver was approved, saying without knowing what the federal government would approve, it was impossible to develop plans. That process is also expected to take some time, though it's unclear how long.

Montana's Medicaid expansion law also has a provision saying if the Supreme Court strikes down work requirements, Montana's program will continue without them until sunsetting in 2025.

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