HELENA — As the U.S. Senate continues to work on its version of Republicans’ “One Big Bill,” a Montana organization has released a new report looking at the possible effects that bill could have on people receiving Medicaid in the state.
(Watch the video for more on how Medicaid could be affected by federal changes.)
“Medicaid is very important for the state's health care system,” said Aaron Wernham, CEO of the Montana Healthcare Foundation.
MHF has been putting together reports on the impacts of Medicaid in Montana for years. The latest report analyzes the federal bill’s proposed changes to Medicaid rules – and what they might mean in this state.
“These are estimates; it's really important to make that clear,” said Wernham. “We're forecasting what might happen; we're not saying that this is definite.”
As of March, 214,167 people in Montana were enrolled in Medicaid or the Healthy Montana Kids program. The MHF report estimates about 31,000 of those people could lose coverage in the first year, with about 27,000 of those likely to be adults on Medicaid expansion – about a third of the current expansion population. The report projects 60% of those losing coverage would be in rural Montana.
The biggest changes would be increasing how often Medicaid recipients have to confirm their eligibility – from once a year to twice a year – and adding work requirements for those on Medicaid expansion. Montana’s Medicaid expansion law has called for “community engagement” requirements since 2019, but they’ve never been implemented because the state hasn’t received a federal waiver to allow them to move forward.
Supporters of the federal bill, including Montana Republican Reps. Ryan Zinke and Troy Downing, have argued the Medicaid changes will help root out “waste, fraud and abuse” and strengthen the program by making sure only people who should be on it are on it.
Wernham said he’s concerned the effects might go farther than that.
“We project that for the simple reason that the government's not perfect,” he said. “It takes a lot of work for a government to implement all of these new systems to figure out who's meeting work requirements, who's exempt from work requirements. When we've seen that sort of requirement put in place in other states, a lot of people lose coverage who actually should be exempt from the new requirements.”
The report also estimates, over the next ten years, the state could see $5.4 billion less in health care spending for low-income Montanans, with 80 percent of that coming from reduced federal Medicaid spending. It said Montana might have a larger drop in federal spending compared with other states.
“The federal government pays a pretty high share of our program, so that means as changes happen, we may lose a higher proportion of federal dollars than other states,” Wernham said.
This comes a few months after the Montana Legislature voted to extend Medicaid expansion in the state. Wernham said the impacts from the “Big Bill” would not be as significant as if the Legislature had not renewed that program.
The final language of the “Big Bill” is still being worked out. Republicans in Congress have said they hope to pass the bill by July 4.
