A U.S. District Court judge in Washington, D.C., blocked work requirements in Arkansas and Kentucky's Medicaid expansion programs Wednesday, a day after Montana's Legislature advanced a bill to continue the state's expansion program with the addition of work requirements.
The Montana Legislature must decide this session how it wants to extend the program that covers 96,000 Montanans who earn up to 138 percent of the federal poverty level. Those limits will be $17,236 for an individual and $29,435 for a family of three in April.
In 2015, lawmakers from both sides of the aisle joined to expand Medicaid in Montana, but only with an expiration date of this summer to provide a chance to review the program.
All Democrats in the Legislature support expansion. Their party had a bill to continue the program much in its current form, a proposal that was defeated Tuesday night as the GOP-carried bill advanced. Republicans hold a majority in the Legislature.
To get enough support, Republican Rep. Ed Buttrey, of Great Falls, crafted legislation with added work requirements. That makes it possible for some more moderate Republicans, who ran on reforming the program, to vote for expansion to continue. About seven in 10 covered on expansion now are already working.
That dynamic was illustrated in Tuesday night's state House Human Services committee vote, when three Republicans joined all Democrats to advance Buttrey's bill, while more conservative Republicans voted against it.
Many Republicans in Montana have been frustrated with the costs of the program because double the number of people expected to sign up have enrolled since 2016. But even the most conservative members of the Legislature who won't vote for Medicaid expansion in any form acknowledge Montana's program will likely continue.
What's less clear is how the judge's ruling Wednesday would change anything here. Mostly it's too early to tell.
Democrats pushed Buttrey for a key amendment, passed Tuesday evening, that lifted a clause ending the program in Montana if work requirements were struck down in court. The bill now has a sunset in six years if the U.S. Supreme Court invalidates work requirements. Kentucky's case is expected to reach the top court.
"It's not a surprise that ruling came out," said Rep. Kim Abbott, a Democrat from Helena and minority whip in the House. "We recognized both the policy and legal challenges of a strict work requirement and that's why a severability clause is so important."
Abbott said Democrats have a lot of concerns about implementing work requirements, which is why they tried to limit what's in Buttrey's bill.
Other questions too early to determine are whether the decision in Washington would have jurisdictional relevance to Montana since it's in a different U.S. Circuit court system, and whether Montana's work requirements and reporting system would create the same barriers the judge found “arbitrary and capricious” in Kentucky.
Tuesday night Buttrey's bill was heavily amended to broaden exemptions to work requirements. Many who have watched the bill progress said Wednesday evening they are still digesting the amendments and how it would rank Montana against states like Arkansas.
Studies have found many in Arkansas might have met work requirements but were unable to report their hours, something that caused them to lose coverage. Arkansas has often been held up as a negative example by those in Montana who oppose the addition of work requirements.
Buttrey changed his bill Tuesday night in an attempt to ease that issue. The bill leaves it up to the state health department to establish rules for how work hours and exemptions would be reported.
Montana's bill would also trigger an audit if more than 5 percent of people covered are suspended for not meeting work requirements, and pause suspension if that reaches 10 percent.
Buttrey doesn't see the decision Wednesday as having any bearing in Montana, saying the case needs to work through the court system.
"It'll take however long it takes to work its way up through the federal process," Buttrey said.
A legal note issued on an earlier version of the bill did not address pending challenges in other states.
Work requirements weren't an option when Montana originally expanded Medicaid four years ago. But in 2018 the Trump administration issued guidance that states could impose them. Since then eight states have been approved for adding that provision to their state's expansion and seven more are pending, according to the Kaiser Family Foundation. Not all states with approved waivers have work requirements in place.
The decision Wednesday puts Arkansas' requirements on hold. Kentucky's have not been enacted yet because of legal challenges.