Phil Drake, Helena IR
A group of Montana health care providers said Thursday if the state Legislature does not renew Medicaid expansion during its 2025 session it could have dire consequences, not only for the 77,000 Treasure State residents now on the program, but for providers and communities as well.
The 2025 state Legislature, which convenes Jan. 6, will consider whether to keep the Montana Medicaid program as it is or allow major parts of it to expire in July, organizers of the discussion at Hometown Helena, a grassroots civic group, said. They also encouraged attendees to contact their state lawmakers and urge them to support renewal.
Montana first expanded Medicaid under the Affordable Care Act in 2015, allowing able-bodied adults earning less than 138% of the federal poverty line to enroll. It renewed the program once again in 2019 and a 2025 sunset was approved and will expire in June if not renewed by lawmakers. Total Medicaid enrollment is almost 228,000 people, including roughly 77,000 covered under expansion, according to recent numbers. Traditional Medicaid covers low-income adults, children, pregnant women, elderly adults and people with disabilities.
Seven health care providers spoke at the Hometown Helena meeting at Helena College, including Bob Olsen, president and CEO of the Montana Hospital Association; Wade Johnson, CEO of St. Peter’s Health; Craig Aasved, CEO of Shodair Children’s Hospital; John Goodnow, CEO of Benefis Health System; Richard Miltenberger, interim CEO of PureView Health Center; Todd Wilson, executive director of the Helena Indian Alliance and Justin Tiffany, CEO of Billings Clinic Broadwater.
Olsen said while it is called Medicaid expansion, it will not expand beyond what it is today.
Medicaid is a state and federal partnership, he said, adding that under the expanded program, the federal government pays a 90% federal-10% state share, which was a feature of the Affordable Care Act.
He said when the state extended Medicaid, they saved taxpayers $37 million and Montana reportedly receives $25 in health care services for every General Fund dollar spent.
There is at least one person on Medicaid in at least 80% of Montana’s employer community, Olsen said. This a program for part-time workers in hotels, restaurants and farms.
He said that during the renewal debate people will hear claims that there should be some kind of work requirement.
“And I am here to tell you, ‘Great, they are working,’” he said, adding people are engaged in their communities. He said people stay on the program an average of two years or fewer. He said 16% of the workforce is on Montana Medicaid and 66% of Medicaid-eligible people are working. And overall, 76% of program participants are working full or part time or attending school.
“So it is a hand up, not a handout,” Olsen said, adding the program supports 7,500 Montana jobs.
He said if the program is discontinued, it will come back to employers, the service sector and low-income people.
“That is why the impact will be significant if we don’t’ keep the program,” Olsen said.
He said if discontinued, the taxpayers will have to pay more money. Olsen said later in the meeting that he believed renewal had enough support in the House to pass, but faced a tougher challenge in the Senate.
Olsen said you’d think that with all the benefits, the program would make a “whistling sound” as it ripped through the legislative process.
“But it is not going to be that way,” he said.
Conservative groups that oppose renewal have said the program’s enrollment and costs are bloated and harms access to care for the most vulnerable. And they said Medicaid expansion’s impact on overall health was misleading.
Johnson, of St. Peter’s, said the health care provider has been able to treat patients earlier in the process than before because they have access to care.
Patients who have insurance will access health care earlier, he said.
Since expansion, having more insured patients has helped stabilized the finances of St. Peter’s Health so that it has been able to invest more in the community than ever in its history.
It has allowed St. Peter’s to invest in services with other partners that are not reimbursed, such as a crises health team that works with mental health issues in the community.
Miltenberger of PureView said they have been able to increase their behavioral health specialists from two to nine. This helps deal with people on an out-patient basis.
He said expansion allows them to “Catch them early, take care of them and take care of our folks.”
Goodnow of Benefis of Great Falls and Helena said they serve a lot of rural areas with small hospitals. He said Medicaid allows big hospitals to do more in rural communities to keep those hospitals operating.
He said it is not a good situation to be without health insurance. He said it is an important program and will be a tough battle in the Legislature because of philosophical differences.
“But I really, really hope it will continue,” he said, adding it was good for the state of Montana.
Aasved of Shodair said when behavioral health services are available to parents the kids benefit. He said their focus is on preventative services to prevent in-patient stays.
He said Shodair has employees on Medicaid expansion.
“The workforce is a difficult enough issue, so we need all the help we can get and this has been a program that has been very beneficial for some of our employees,” Aasved said.
Wilson of the Helena Indian Alliance said they have been able to increase staff for mental health care and substance abuse and have grown from two to 14 mental health providers, a director and support staff.
He said they were able to bill for treatments of non-Natives and non-beneficiaries through Medicaid expansion.
Wilson said as an administrator he has always worried what will happen if the program goes away.
“It is scary to think of going back to 2015 levels,” he said. “We do not want to cut services but we are going to have to deal with the reality if it comes to that.”
Tiffany of Billings Clinic Broadwater said expansion means access to care.
He said they have been able to stabilize primary care and that Medicaid expansion accounts for about $500,000 of our bottom line.
Comments