Rep. Ed Buttrey in committee

Great Falls Rep. Ed Buttrey, a Republican, explains amendments to his bill to extend Medicaid expansion in Montana. 

The Montana Legislature is expected to continue the state's Medicaid expansion program, but a bill to do so faced a detour in its path to approval Friday.

House Bill 658 lifts the June expiration date on the program that extends Medicaid coverage to 96,000 low-income Montanans and adds work requirements. It cleared the House on a 61-37 vote last month, but on Friday was tabled in a Senate committee — in an effort led by one of its co-sponsors — before being put back on track by the full Senate.

The bill is carried by Rep. Ed Buttrey, a Republican from Great Falls who brought the legislation that originally expanded Medicaid in Montana in 2015. Expansion covers those earning up to 138% of the federal poverty level. That's $17,236 for an individual and $29,435 for a family of three.

House Bill 658 is the remaining vehicle to continue expansion. Democrats strongly opposed the work requirements originally proposed in the bill, but supported it after their own party's bill was defeated and Buttrey's legislation was heavy amended. The changes drastically reduced the number of people expected to lose coverage under the work provision, from 59,000 to an estimated 4,000.

Sen. Jason Small, a Republican from Busby, is the co-sponsor who brought the motion in the Senate Public Heath, Safety and Welfare Committee to table the bill he supports. 

"I just stopped a big fight we didn't need to have," Small said. The committee was expected to make several attempts to further amend the bill. Even after hours of debate, the 6-4 Republican majority committee was still likely to table it.

Later Friday, Senate Majority Leader Fred Thomas, a Republican from Stevensville, made an unopposed motion to bring the bill back to life and send it to the Senate Finance and Claims Committee, where it was likely to end up anyway. That committee is expected to hear the bill Monday.

There's a general mood even among Republicans who oppose Buttrey's bill that it will pass the Legislature. Gov. Steve Bullock said earlier in the week he supports the bill in its current form.

Nine Republicans in the Senate, members of the so-called Solutions Caucus, have signed on to support Buttrey's expansion bill. Counting on the support of all 20 Democrats in the Senate, that's enough to get the bill across the finish line. 

But that doesn't mean all Republicans are happy about it.

"The Solutions Republicans forgot to add an 'S' in front of it. Because their solutions are socialist solutions. That is a socialist bill," said Sen. David Howard, a Republican from Park City who chairs the Senate committee that tabled the bill.

Howard acknowledged the bill will likely pass the Senate, even though he thinks it gives hospitals an unfair financial advantage. He and others on the committee zeroed in Friday on supplemental payments hospitals get to help offset the costs of providing Medicaid services.

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Some hospitals already get a lot of tax breaks and other benefits, Howard said. He objects to supplemental payments he says further boost their bottom line. The payments come from a utilization fee the hospitals pay that is then leveraged to get federal matching funds. The fee would rise from $50 per bed day to $70 in Buttrey's bill. The increase is meant to help pay the state's share of expansion's costs, but Howard said the money that goes back to hospitals in supplemental payments — about $300 million — is just padding hospitals' bottom line.

Bob Olsen, senior vice president of the Montana Hospital Association, said hospitals are reimbursed less for Medicaid services they provide than what private insurance would pay them. The supplemental payments help hospitals make up the difference.

"It allows us to close the gap in our costs," Olsen said.

Hospitals will also pay a 0.9% tax on outpatient revenue to help cover the state's cost of expansion under an amendment Buttrey discussed Friday. That would increase the fee from what's proposed in the bill now. The planned change is coming because Buttrey also wants to eliminate using a 2.5% premium tax on the Montana State Fund, the quasi-governmental workers' compensation program, to pay for the state's share of expansion cost.

Buttrey said that change came after he heard concerns from businesses that get workers' compensation coverage from the State Fund about their rates going up.

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