HELENA — A bill to extend Montana’s Medicaid expansion program cleared one more key hurdle in the state Legislature on Thursday.
House Bill 245, sponsored by Rep. Ed Buttrey, R-Great Falls, would remove the June 30, 2025, sunset date on Medicaid expansion. Senators endorsed it 29-21 in a preliminary vote, with 11 Republicans joining all 18 Democrats in support.
“Do it for the 80,000 people that need it in our state, and the people that they support,” said Sen. Gayle Lammers, R-Hardin.
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The Medicaid expansion program directs federal and state funding to support health care for people making less than 138% of the federal poverty level.
State leaders approved the program in 2015, and then renewed it for another six years in 2019.
Supporters of HB 245 said the program has shown over the last ten years that it boosts hospitals and promotes health without encouraging people to remain on it for extended periods.
“When people don't have access to health care, they get sick; when they don't have access to basic health needs, basic needs for addiction, things like that, they become a lag on our state,” Lammers said. “With this program, they get to combat that because they have access to real health care – they can be productive, they can get a job.”
Sen. Shane Morigeau, D-Missoula, talked about the impact programs like this have had on his family.
“You know, without rural hospitals, I don't think my dad would be here,” he said. “Without things like Medicare or Medicaid — 13,000 people in Indian communities like my dad would go without things like basic health care costs.”
Republicans opposed to the bill said they had hoped to see more changes to Medicaid expansion. They wanted stronger work requirements and warned that the federal government could cut its support for Medicaid expansion — putting an additional financial burden on the state and potentially requiring legislators to come back in a special session.
“We're going to be back here, and I'm going to tell you I told you so,” said Sen. Carl Glimm, R-Kila.
But many of them said they felt the result was already clear.
“I think the ship’s sailing on this one, out of our body, so I'm speaking to the governor,” said Sen. Jeremy Trebas, R-Great Falls. “I hope our governor would at least push for a compromise to institute real work requirements, not the fake community engagements that are in this bill.”
HB 245 cleared the House less than two weeks ago. It received a hearing in a Senate committee on Monday, and the committee voted to advance it that same day.
Senate Majority Leader Sen. Tom McGillvray, R-Billings, opposed the bill on the floor, but was one of the senators who voted to move it out of committee. On Thursday, he explained that vote by saying opponents didn’t have the votes to stop it, and he believed letting it move on was the best option.
“We could hold it in committee, but it would be blasted on the floor,” he said. “We could put amendments on it in committee, but if we did and it was blasted on the floor, they’d be stripped off. Or we could not put amendments on in committee and just go to the floor. We could be putting amendments on it today, but we're not doing that. I just did that vote because I felt it was the best for the body, was the best for the Senate.”
Sen. Dennis Lenz, R-Billings, who chaired the committee, said he and McGillvray had agreed one of them would vote to let the bill go forward.
“On some level, in the midst of all of this rancor that we've had, it's a cordial move,” he said. “I mean, we understand that we don't have the votes, and we would like it to stop sucking air out of the room.”
Afterward, leaders referred the bill to the Senate Finance and Claims Committee, which reviews all bills that involve a large amount of state money. It will need to go through that committee before returning to the floor for one final vote. Once it passes that vote, it will head to Gov. Greg Gianforte’s desk.
Gianforte included Medicaid expansion in his budget proposal for this session. He told reporters last week that the existing law already called for work requirements through its community engagement provisions, and that the state would be asking the federal government to approve a waiver to allow them to finally implement those requirements.
“We'll look at the final bill,” he said. “It's a safety net we need to have, but we also have to make sure the people that get in the safety net doesn't cause the safety net to collapse under its weight.”
This may not be the last time Medicaid expansion is debated on the floor. Senate President Sen. Matt Regier, R-Kalispell, who’s been skeptical of continuing the program, has introduced Senate Bill 334, which would tighten the eligibility requirements.
