HELENA, Mont. \u2014 Despite concerns about what Congress and the Trump administration might have planned for Medicaid, Montana\u2019s Republican-led legislature and GOP governor appear ready to keep the state\u2019s Medicaid expansion program in place beyond its scheduled end date this summer.<\/p>\n
State lawmakers don\u2019t have the luxury of waiting until the federal picture sharpens. They must decide before the session ends in early May whether to lift a June 30 sunset date for the expansion program, which covers about 76,000 adults.<\/p>\n
However, the likelihood that significant changes lie ahead for the joint federal-state Medicaid program has spurred discussion of whether legislators should \u2014 or can \u2014 prepare for what may be coming. That\u2019s the challenge for lawmakers this session, said Republican state Rep. Jane Gillette during a recent meeting of the budget subcommittee she chairs that works on the Medicaid budget.<\/p>\n
\u201cWhat are the different options we have for bracing ourselves for that?\u201d Gillette said.<\/p>\n
The U.S. House is working on a budget bill to reflect President Donald Trump\u2019s priorities, including allocating up to $4.5 trillion to extend tax cuts that would otherwise expire.<\/p>\n
A plan passed by the House Budget Committee on Feb. 13 calls for $880 billion in cuts over the next 10 years for the committee that oversees, among other things, Medicaid spending. Ideas reportedly under discussion include federal work requirements for some Medicaid enrollees and a decrease in the share of costs the federal government pays for people covered by the expansion program.<\/p>\n
Some of the proposals would shift significant costs to the states, noted Robin Rudowitz, a vice president and the director of the Program on Medicaid and the Uninsured at KFF, a health information nonprofit that includes KFF Health News. If that happens, states will need to raise revenue or cut spending elsewhere to continue the same level of Medicaid coverage, she said.<\/p>\n
There are \u201cno easy answers or options for states in these scenarios,\u201d she said.<\/p>\n
Some states are debating how to prepare for possible federal changes. The South Dakota Legislature is considering a bill<\/a> that would ask voters whether to continue Medicaid expansion if the federal share drops. A bill to repeal Idaho\u2019s expansion program<\/a> outright has been introduced but not heard, while another making it contingent on federal approval<\/a> of several limitations passed the state House<\/a> on Feb. 19. Montana and eight other states have trigger laws<\/a> that could end their expansion programs if the federal contribution rate drops.<\/p>\n The GOP-controlled Montana House of Representatives easily passed a bill to make the Medicaid expansion program permanent on Feb. 10 by a 63-37 vote. Then on Feb. 20, House Bill 245 passed the first of two votes required for Senate approval. Gov. Greg Gianforte has not publicly said whether he would sign the bill, but he previously said he believes the expansion program should continue if strong work requirements are in place.<\/p>\n In late January, the budget subcommittee that Gillette chairs was reviewing Medicaid expansion\u2019s financial implications when talk quickly turned to the possible federal changes, particularly a drop in the federal matching rate.<\/p>\n Republican state Sen. Carl Glimm noted that observers have called a lower federal matching rate \u201cpretty low-hanging fruit.\u201d The change would require congressional action, though, and members noted that could take time.<\/p>\n The federal government pays 90% of the health care costs of expansion enrollees. That group is made up of adults ages 19 to 64 without disabilities and who have annual incomes at or below 138% of the federal poverty level, or $21,597 for an individual.<\/p>\n Until the federal Affordable Care Act allowed states to extend Medicaid to this group, the program was generally limited to low-income children, pregnant women, and adults who are blind, disabled, or at least 65. The federal match for those groups in Montana will be about 62% in the next state fiscal year, which begins in July.<\/p>\n The state spent nearly $1 billion on Medicaid expansion in 2024, with its share of the costs totaling just under $100 million. Budget committee staff said a 10% reduction in the federal share would add roughly $100 million in state costs. If the state\u2019s share goes from 10% to the regular state match of 38%, the state would pay about $280 million more a year for expansion.<\/p>\n Subcommittee member Russ Tempel, a Republican senator, noted that the federal share changed in the past due to unexpected events, such as covid-19.<\/p>\n \u201cSomething\u2019s going to happen that\u2019s unpredictable,\u201d he said. \u201cIt\u2019s happened before, and it\u2019s going to happen again, so we\u2019re kind of a little bit shooting in the dark.\u201d<\/p>\n But Republican Sen. Jeremy Trebas focused on the likely federal changes when urging senators to support his bill to tighten the work requirements in current law and, if federal approval were denied, eventually end the program.<\/p>\n \u201cWe should match up our state policy to coming federal policy so that we\u2019re not caught off guard and expectations aren\u2019t radically altered by what the federal government does,\u201d he said during a committee hearing on Senate Bill 199.<\/p>\n The bill died last week on the Senate floor when all Democrats voted against it, along with a block of nine Republicans who have broken with their party on other issues this session. Roughly the same coalition also killed a bill by Glimm that would have phased out the expansion.<\/p>\n Trebas said recently he expects HB 245 to pass but also believes that federal Medicaid changes could happen more quickly than some think possible, forcing a special Montana legislative session to adjust to those changes.<\/p>\n Gillette, who voted against HB 245, said in a recent interview that the legislature should provide the Gianforte administration with a range of options to allow it to \u201ccourse correct\u201d without further legislative involvement if Medicaid expansion continues and federal changes come down before the legislature meets again in 2027.<\/p>\n State Senate President Matt Regier introduced a bill<\/a> Feb. 15 to limit the expansion population to people below 100% of the federal poverty level and to give the state health agency the ability to limit spending or improve program integrity.<\/p>\n Regier\u2019s bill also would make the expansion program contingent on the federal government approving a \u201ccommunity engagement\u201d waiver, which includes work requirements, and it calls for lawmakers to vote on whether to hold a special session if the federal Medicaid matching rate drops more than three months before the next regular session.<\/p>\n But HB 245 sponsor Rep. Ed Buttrey, another Republican, said in a recent interview that existing law<\/a> takes care of any future decrease in federal support by requiring either the state to increase premiums for the program or the legislature to appropriate additional funds if the program is to continue.<\/p>\n Buttrey also said the legislature can\u2019t make decisions now based on what federal law might be in the future. He said it\u2019s unlikely that federal Medicaid policy would change quickly, but that if it did, the program affects such a large percentage of the state\u2019s population that a special session would be warranted.<\/p>\n \u201cI can\u2019t think of one that\u2019s more important than that,\u201d he said.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n