HELENA, Mont. — Regardless of issues about what Congress and the Trump administration may need deliberate for Medicaid, Montana’s Republican-led legislature and GOP governor seem able to maintain the state’s Medicaid growth program in place past its scheduled finish date this summer season.
State lawmakers don’t have the luxurious of ready till the federal image sharpens. They need to resolve earlier than the session ends in early Might whether or not to carry a June 30 sundown date for the growth program, which covers about 76,000 adults.
Nevertheless, the probability that vital adjustments lie forward for the joint federal-state Medicaid program has spurred dialogue of whether or not legislators ought to — or can — put together for what could also be coming. That’s the problem for lawmakers this session, mentioned Republican state Rep. Jane Gillette throughout a current assembly of the finances subcommittee she chairs that works on the Medicaid finances.
“What are the completely different choices now we have for bracing ourselves for that?” Gillette mentioned.
The U.S. Home is engaged on a finances invoice to replicate President Donald Trump’s priorities, together with allocating as much as $4.5 trillion to increase tax cuts that will in any other case expire.
A plan handed by the Home Price range Committee on Feb. 13 requires $880 billion in cuts over the subsequent 10 years for the committee that oversees, amongst different issues, Medicaid spending. Concepts reportedly beneath dialogue embody federal work necessities for some Medicaid enrollees and a lower within the share of prices the federal authorities pays for individuals coated by the growth program.
Among the proposals would shift vital prices to the states, famous Robin Rudowitz, a vice chairman and the director of the Program on Medicaid and the Uninsured at KFF, a well being data nonprofit that features KFF Well being Information. If that occurs, states might want to elevate income or reduce spending elsewhere to proceed the identical stage of Medicaid protection, she mentioned.
There are “no straightforward solutions or choices for states in these eventualities,” she mentioned.
Some states are debating the right way to put together for attainable federal adjustments. The South Dakota Legislature is contemplating a invoice that will ask voters whether or not to proceed Medicaid growth if the federal share drops. A invoice to repeal Idaho’s growth program outright has been launched however not heard, whereas one other making it contingent on federal approval of a number of limitations handed the state Home on Feb. 19. Montana and eight different states have set off legal guidelines that might finish their growth applications if the federal contribution price drops.
The GOP-controlled Montana Home of Representatives simply handed a invoice to make the Medicaid growth program everlasting on Feb. 10 by a 63-37 vote. Then on Feb. 20, Home Invoice 245 handed the primary of two votes required for Senate approval. Gov. Greg Gianforte has not publicly mentioned whether or not he would signal the invoice, however he beforehand mentioned he believes the growth program ought to proceed if sturdy work necessities are in place.
In late January, the finances subcommittee that Gillette chairs was reviewing Medicaid growth’s monetary implications when speak rapidly turned to the attainable federal adjustments, significantly a drop within the federal matching price.
Republican state Sen. Carl Glimm famous that observers have known as a decrease federal matching price “fairly low-hanging fruit.” The change would require congressional motion, although, and members famous that might take time.
The federal authorities pays 90% of the well being care prices of growth enrollees. That group is made up of adults ages 19 to 64 with out disabilities and who’ve annual incomes at or beneath 138% of the federal poverty stage, or $21,597 for a person.
Till the federal Reasonably priced Care Act allowed states to increase Medicaid to this group, this system was usually restricted to low-income kids, pregnant girls, and adults who’re blind, disabled, or not less than 65. The federal match for these teams in Montana might be about 62% within the subsequent state fiscal yr, which begins in July.
The state spent practically $1 billion on Medicaid growth in 2024, with its share of the prices totaling just below $100 million. Price range committee employees mentioned a ten% discount within the federal share would add roughly $100 million in state prices. If the state’s share goes from 10% to the common state match of 38%, the state would pay about $280 million extra a yr for growth.
Subcommittee member Russ Tempel, a Republican senator, famous that the federal share modified prior to now on account of surprising occasions, similar to covid-19.
“One thing’s going to occur that’s unpredictable,” he mentioned. “It’s occurred earlier than, and it’s going to occur once more, so we’re type of somewhat bit taking pictures at nighttime.”
However Republican Sen. Jeremy Trebas centered on the doubtless federal adjustments when urging senators to assist his invoice to tighten the work necessities in present legislation and, if federal approval have been denied, finally finish this system.
“We should always match up our state coverage to coming federal coverage in order that we’re not caught off guard and expectations aren’t radically altered by what the federal authorities does,” he mentioned throughout a committee listening to on Senate Invoice 199.
The invoice died final week on the Senate flooring when all Democrats voted in opposition to it, together with a block of 9 Republicans who’ve damaged with their occasion on different points this session. Roughly the identical coalition additionally killed a invoice by Glimm that will have phased out the growth.
Trebas mentioned lately he expects HB 245 to cross but additionally believes that federal Medicaid adjustments might occur extra rapidly than some suppose attainable, forcing a particular Montana legislative session to regulate to these adjustments.
Gillette, who voted in opposition to HB 245, mentioned in a current interview that the legislature ought to present the Gianforte administration with a variety of choices to permit it to “course appropriate” with out additional legislative involvement if Medicaid growth continues and federal adjustments come down earlier than the legislature meets once more in 2027.
State Senate President Matt Regier launched a invoice Feb. 15 to restrict the growth inhabitants to individuals beneath 100% of the federal poverty stage and to present the state well being company the power to restrict spending or enhance program integrity.
Regier’s invoice additionally would make the growth program contingent on the federal authorities approving a “group engagement” waiver, which incorporates work necessities, and it requires lawmakers to vote on whether or not to carry a particular session if the federal Medicaid matching price drops greater than three months earlier than the subsequent common session.
However HB 245 sponsor Rep. Ed Buttrey, one other Republican, mentioned in a current interview that current legislation takes care of any future lower in federal assist by requiring both the state to extend premiums for this system or the legislature to applicable further funds if this system is to proceed.
Buttrey additionally mentioned the legislature can’t make choices now primarily based on what federal legislation is perhaps sooner or later. He mentioned it’s unlikely that federal Medicaid coverage would change rapidly, however that if it did, this system impacts such a big share of the state’s inhabitants {that a} particular session could be warranted.
“I can’t consider one which’s extra vital than that,” he mentioned.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.
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