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Rep. Ed Buttrey Medicaid expansion file

Rep. Ed Buttrey, R-Great Falls, listens to opponents of his bill that would extend Medicaid expansion with work requirements during an all-day hearing at the state Capitol last week.

Legislators got a glimpse Friday of a state estimate showing the Republican version of a bill to continue Medicaid expansion with added work requirements would result in about half the 96,000 people on the program losing coverage.

The fiscal note is attached to Rep. Ed Buttrey's House Bill 658, which was expected to be voted on in the House Human Services committee Friday.

That vote, and another on the Democrats' proposal to continue the program as is was pushed back to Monday, or Tuesday at the latest, because the fiscal note on Buttrey's bill was not published until late Friday afternoon. The Democrats' bill is House Bill 425, carried by Helena Rep. Mary Caferro.

A Medicaid expansion bill must move to the state Senate by April 1 to meet transmittal deadlines.

Montana expanded Medicaid to those earning up to 138 percent of the federal poverty level four years ago and put in a sunset of this summer so lawmakers would come back and review the program.  In April, the 2019 federal poverty level will be $17,236 for an individual and $29,435 for a family of three.

While there's general agreement expansion should continue, Republicans and Democrats are divided on how.

The estimate published Friday shows about 48,000 people would be covered under the Republican bill. The fiscal note for the Democrats' bill predicts about 100,000 would be covered under their proposal.

Though half the number of people are covered, the Republican bill is estimated to cost the state only $2.2 million or so a year less than the Democrats' proposal. 

That's because the fiscal note on the Republican bill predicts the state would need to add 84.5 full time positions, including 77 in the state health department. Those employees include people to coordinate eligibility, the reporting and tracking of hours worked, audits to ensure reports are accurate and more.

Buttrey has said he thinks the state could absorb those functions with existing employees.

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Another notable cost estimated for Buttrey's bill is $4.6 million to modify and enhance IT systems that would track eligibility.

Fiscal notes are produced by the governor's Office of Budget and Program Planning with input from state agencies that would be affected by the legislation proposed.

Buttrey has raised concerns about what the note for his bill would look like, given that the governor is a Democrat and opposed to work requirements. In the past Buttrey called fiscal notes "a political tool." He did not sign this note.

The note for Buttrey's bill gets its numbers for how many people would lose coverage from a study published by George Washington University's Milken Institute School of Public Health. Buttrey has already objected to previous reports by that institute based on earlier versions of his bill. He's also said the bill will be amended, though has not clarified how.

The report from George Washington University was independently produced. It was in part funded by the Montana Healthcare Foundation, which supports continuing expansion without work requirements.

A spokesperson for the governor's office said Friday "it is common to use non-partisan, independent analyses, particularly if the analysis draws information from other state experiences, in fiscal notes."

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