Montana Legislature

Montana’s 100 House representatives take their oath of office in the Montana state capitol on Monday in Helena.

If an early version of a Republican remake of Montana’s Medicaid expansion becomes law, up to 43,000 low-income people could lose health coverage, according to a new report.

The Center for Health Policy Research out of George Washington University released the report Wednesday. The findings state proposed work requirements and increased premiums would whittle how many people can use the health program that covers roughly 95,000 Montanans.

Lead author Leighton Ku said the report estimates between 31,000 and 43,000 Montanans would lose coverage.

“Many people likely to lose coverage are already working when they can or they live in rural areas and are unable to find a job,” Ku said.

Montana’s expansion is due to expire June 30. Many lawmakers have said they want a version of the program to continue, but there’s a split on what shape it should take.

Democrats have said the program works as is, for the most part. They point to more people signing up for the coverage than expected as evidence that the expansion, called the Help Act, is working.

Republicans have said the high enrollment is a symptom of people abusing the system.

Rep. Ed Buttrey, R-Great Falls, brought the first version of the program before lawmakers. Now he’s proposing what he’s called “Help Act 2.0.” As he’s said in the past, the proposal seeks to ensure enrolled people “have some skin in the game.”

Tuesday’s report is based on Buttrey’s draft legislation, which is not available online. Buttrey didn't immediately return a request for an interview.

Called the Medicaid Reform and Integrity Act, the bill would require 19- to 59-year-old enrollees to work 80 hours a month or lose coverage after three months unless they have an exception, according to the report.

It would also raise the monthly premium recipients pay for the coverage.

That would further increase for those enrolled more than two years. Buttrey has said the program is intended as a short-term solution and people who rely on the expansion indefinitely contradict that.

Montana Gov. Steve Bullock released a statement following the report Wednesday in which he called the proposed changes damaging.

“We already have a successful bipartisan approach to Medicaid expansion that ensures healthy people are finding and keeping good jobs,” Bullock said. “It doesn’t make sense to me that we would abandon this approach all to spend more money, kick up to 43,000 Montanans off of their coverage, and hurt our rural hospitals.”

Montana created a voluntary work program that connects enrollees with ways to find work or better paying jobs without threatening to revoke coverage.

In a statement Wednesday, House Democratic Leader Casey Schreiner of Great Falls called the report findings staggering.

“If there was ever any doubt that work reporting requirements and labor quotas would be a disaster for our state, this research, conducted by leading experts on work requirements, puts them all to rest,” Schreiner said.

Ku said a lack of internet service could risk the coverage of those who meet Medicaid work requirements or qualify for exemptions because of the draft bill’s reporting requirements.

Montana is one of many places where lawmakers disagree on how their Medicaid programs should work. Each state's program is unique but the overarching argument is what residents should — or shouldn’t — have to do to receive help.

Lawmakers in Kentucky are trying to weave more requirements into the state’s Medicaid program. A federal judge struck down that plan in June 2018, but the case is back in court. Opponents have argued the requirements are illegal and — similar to Montana Democrats’ arguments — counter Medicaid’s purpose.

Arkansas is the only state to implement work requirements so far. More than one in five of those subject to the new policy lost coverage in the first seven months, according to the nonpartisan Center on Budget and Policy Priorities.

Katheryn Houghton can be reached at or at 582-2628. Follow her on Twitter @K_Hought. 

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