GOP Medicaid draft bill has ‘engagement’ requirements; new fees for hospitals, insurers

Posted at 5:41 PM, Mar 04, 2019
and last updated 2019-03-04 20:10:42-05

HELENA – The latest draft of the Republican plan to continue expanded Medicaid in Montana requires most recipients to self-report 80 hours a month of “community engagement,” which could include work, workforce training or community service – a significant change from the current program.

The draft of the bill, which will be introduced this month by Rep. Ed Buttrey, R-Great Falls, also would help fund the state’s $60 million-a-year share of the program with a new fee on hospital outpatient revenue, premium taxes on the state workers’ compensation fund, and a new premium tax on non-profit health insurers.

Buttrey told MTN News Saturday that he’s reviewing the draft and could make an additional change before introducing it, but that it’s “pretty much done.”

Buttrey’s bill is the Republican proposal to continue Medicaid expansion, which provides government-funded health care to about 95,000 low-income adults in Montana. The program, funded largely by the federal government, is set to expire June 30, unless reauthorized by the Legislature.

The draft also estimates the budget for the entire program at $1.49 billion over the next two years. The federal government pays about 90 percent of the costs.

State Rep. Mary Caferro, D-Helena, already has introduced the Democratic proposal to continue expanded Medicaid. Both bills are scheduled for their first hearing before the House Human Services Committee on March 16.

Expanded Medicaid, which began in Montana in 2016, is part of the 2010 Affordable Care Act, also known as “Obamacare.” It pays health-care bills for able-bodied adults who earn up to 138 percent of the federal poverty level, or about $17,200 a year for a single person.

So far, 37 states have authorized the expansion.

Gov. Steve Bullock and fellow Democrats have said the program should be continued with minimal additional restrictions, arguing that it has been an unmitigated success, bringing health care to thousands of low-income Montanans, keeping rural hospitals open, and creating thousands of new jobs.

Caferro’s House Bill 425 continues the program without work requirements for recipients. The Bullock administration says 70 percent of the people on the program already are working, and that creating new requirements would be more costly than they’re worth.

Yet Republicans, who control majorities at the Legislature, have said the program needs some additional restrictions.

The latest draft of Buttrey’s bill would make multiple changes in the program and state health-care laws, including:

• The requirement that recipients have 80 hours a month of “community engagement,” which could be a job, efforts to obtain unemployment payments, workforce training, part-time enrollment in higher education, volunteer work approved by the state, or being in a mental-health or substance-abuse treatment program.

Some recipients would be exempt from the community-engagement requirement, such as full-time caregivers of children or disabled adults, full-time students or anyone who is hospitalized or seriously ill.

Participants in the program would self-report their engagement duties and the state would audit these responses.

• A requirement that enrollees complete a health-risk assessment and “employment readiness” form within six months after being covered.

• A new grant program, funded at $3.5 million over two years, to encourage employers to train Medicaid recipients for jobs that will enable them to get higher-paying jobs so they can obtain their own health insurance.

• Limits on medical-malpractice liability.

• A more stringent “taxpayer integrity fee,” which is an asset test designed to charge additional fees to people who may be eligible for coverage because of their low income but have considerable financial assets, such as real estate.

• Requirements that the state verify that participants are Montana residents.

• A fee of 0.825 percent on hospitals’ outpatient revenue, to help finance the program.

• Requirements that the Montana State Fund pay the state premium tax of 2.75 percent, with the revenue going to finance Medicaid expansion. The State Fund writes workers’ compensation insurance for about 60 percent of Montana businesses.

• A new 1 percent premium tax on nonprofit health insurers, such as the Montana Health Co-op – also to help fund the Medicaid program.