Medicaid expansion ‘crucial,’ Montana Dems say

Medicaid expansion is a “crucial priority” for Democrats in the 2025 Montana Legislature — but Democratic leaders said Monday they want to do better than just continue the program.

Rep. SJ Howell of Missoula said Democratic lawmakers will bring legislation that would make the program better, such as helping seasonal workers more easily keep their insurance.

“Continuing our current Medicaid program is the most important job that we have, but that is the floor, and we do have a vision for ways we can improve the program,” said Howell, also House minority whip.

Last week, Republican Gov. Greg Gianforte released his budget proposal for the 2027 biennium, and it includes Medicaid expansion, which covers nearly 80,000 Montanans.

The program will sunset in June 2025 without action by lawmakers.

At a video news conference Monday, Howell and Rep. Mary Caferro, a Helena Democrat and vice chairperson of appropriations, offered their reactions to the governor’s budget and discussed Medicaid expansion as a priority for Democrats.

“We are really pleased that the governor’s budget includes our current Medicaid program as part of the base budget,” Howell said.

On the other hand, Caferro said the most recent income tax cut is the “worst one of the three” such cuts the governor has proposed, especially in light of increases to property taxes that she said Republicans didn’t address in 2023.

The income tax cut means the top 20% of earners get 75% of the cut, and everyone else has to share the remaining 25%, she said. She said it means the lowest earners will get a pittance.

In the meantime, Caferro said Democrats will offer targeted solutions that are fair and that benefit working families, children and elderly people, for instance. She cited a child tax credit bill as one example, and she questioned the benefits of an earlier income tax cut.

“Has it made housing more affordable? No,” Caferro said. “Has it made a loaf of bread more affordable so a parent can feed their kids? No. Has it brought down property taxes, or in some way mitigated the harm that property taxes have placed on the shoulders of Montanans? No.”

In the last session, Republicans approved as much as $675 in property tax rebates for 2022 and 2023, but many people who qualified for them never received them, at least in the first year, and Democrats said the rebate also left out renters.

In response to property tax increases, however, the governor also convened a property tax task force, which delivered proposals the 2025 legislature will take up.

This month, Gianforte handily won re-election, and although Republicans lost their supermajority from 2023, they will still control the Montana Legislature with majorities in both chambers.

Property taxes and Medicaid expansion are expected to be significant topics of debate for the 2025 legislature.

Lawmakers already have been hearing reports on the effects of Medicaid expansion in Montana, including from groups that have lobbied against expansion in other states, according to reporting from KFF Health News.

The expansion program covers people with incomes up to 138% of the federal poverty level, or roughly $21,000. The federal government pays 90% of the expansion cost, and the state pays 10%.

Democrats generally see that math as a good deal for the economy and the health of Montanans. However, some Republicans worry the state could be obligated to pay even more down the line should the federal government contribute less than 90% in the future.

At the press conference Monday, Howell and Caferro said they believe Montanans and the leaders they elected see value in the program.

Howell said some Republicans would prefer to see the program end, but Howell and Caferro both said they believe a diverse group of legislators will support its renewal.

“I think that every legislator, Republican or Democrat, understands just how important our Medicaid program is,” Howell said.

A Department of Public Health and Human Services dashboard had 78,284 adults on Medicaid expansion and 46,255 adults on traditional Medicaid as of August, the most recent month of data posted. Counting children, more than 222,000 Montanans are enrolled in Medicaid altogether, according to the dashboard.

Caferro said the Medicaid expansion program is “extremely popular,” and it has support from diverse groups. For example, Caferro said a law enforcement officer said Medicaid expansion benefits officers because it supports people in crisis, and not only in the moment.

“What’s even more important is that they have aftercare because they have a payer source,” Caferro said. “Many folks did not have a payer source before.”

Both Democrats also said they don’t want to see more restrictions placed on people who are insured through Medicaid. Work requirements generally aren’t allowed under federal Medicaid law, Howell said, and Caferro described them as “code clutter” and “red tape” anyway.

An earlier report from the Montana Healthcare Foundation found just 3% of Montanans have no impediment to working and do not work.

The legislators also said they would like to see the program work better for Montanans. For example, Montana used to have “continuous eligibility,” which the Democrats said helps both the person covered under Medicaid and the provider.

Howell said it means a seasonal worker who wants to pick up a few extra shifts runs into fewer problems under “continuous eligibility,” which means a person who qualifies for Medicaid has coverage for a year and doesn’t have to report picking up those hours to see if they still qualify.

Caferro said it benefits providers because when people lost Medicaid coverage in redetermination — “through no fault of their own” — nursing homes ended up three months behind getting their reimbursements. She said continuous eligibility creates predictability for businesses caring for people covered through Medicaid.

“That creates a more seamless system,” Caferro said.

When it comes to Medicaid, Howell said Democrats are generally open to discussions about things like provider rates, where and when people can get care, increasing postpartum access — generally, “the ways we can leverage Medicaid to make Montanans’ lives better.”

Supporters of Medicaid expansion have said rural hospitals could close without it, and Howell and Caferro both said that’s not an exaggeration. Caferro said at recent listening sessions in 13 or so communities, health care leaders said the program is critical to their ability to care for community members.

“They are on the margins,” Caferro said.

And Howell said no rural hospitals have closed in Montana since the program started in 2015, but in the last decade or so, 136 rural hospitals have closed nationwide, and 75% were in states that did not have Medicaid expansion.

“The threat to rural hospitals is real,” Howell said.

Keila Szpaller is deputy editor of the Daily Montanan, a nonprofit newsroom.