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Lee Newspapers: Legislature passes Medicaid expansion

April 18, 2019


The Montana Legislature on Thursday passed a bill to continue Medicaid expansion with the addition of work requirements and a six-year expiration date.


On a 61-35 vote, the Montana House had lawmakers' final say on the policy that's dominated much of this session, from an all-day Saturday marathon hearing to late-evening committee votes filled with debate over the best way to continue the program that covers about 96,000 Montanans. The bill now heads to Gov. Steve Bullock, who said Thursday he will sign it.


The showdown had been looming since 2015, when the Legislature first passed a bill to expand Medicaid in the state with a termination date of this summer, intended to give lawmakers a chance to review the program. Expansion extends Medicaid coverage to those earning up to 138% of the federal poverty level. The 2019 federal poverty level is $17,236 for an individual and $29,435 for a family of three.


Many of the same players from four years ago are still at the Capitol, from Republican Rep. Ed Buttrey of Great Falls — who carried the 2015 bill and this year's version — to Bullock, a Democrat who has championed the program. Helena Democrat Rep. Mary Caferro, who advocated for expansion in 2015, had her own bill this session to continue the program, but without a work requirement. That was defeated in March.


"It’s been a long, long haul," said Buttrey, who faced heavy criticism for not introducing his bill until past the midway point of the 90-day session. "It was in our best interest to continue the program to help as many folks as we can, especially with drug addictions (and) mental illness. Those are big things that plague Montana, and they’re very expensive. And everyone that we can treat and have success in those areas is a huge win for everyone."


Though Bullock originally supported Caferro's bill, unveiled at the start of the session, he said Thursday the compromise that emerged is good for the state.


"I worked with both the sponsor of the bill and others, Democrats and Republicans, to try to find something that not only preserved health care for individuals but is something I think we can walk out, Democrats and Republicans, with our head held high. I think we accomplished that on this bill," Bullock said Thursday. 

Read full story online here.

Billings Gazette: Rural Montana needs Medicaid expansion

April 10, 2019
Billings Gazette Editorial Board

The Montana Senate will soon take one of the most important votes of the biennial session. Our 50 senators will decide whether 96,000 Montanans can keep their health coverage past June 30.


Once again, we call on our elected leaders to do the right thing: Renew Medicaid expansion, the successful program that Montana started in January 2016 that has reduced the state's uninsured ranks by more than half. Allow very low-income Montanans to continue to have access to quality, affordable health care. Assure low-wage, seasonal and small business workers that they will have continuing health coverage. Continue the state's major source of payment for treatment of substance abuse disorders and mental illnesses — a lifeline for thousands of Montanans who need help to get their lives and jobs back.


Every one of Montana's 56 counties has Medicaid expansion enrollees. Every county has businesses that employ Medicaid enrollees. But without approval by a majority of senators, the benefits of Medicaid expansion will end in less than three months. 


In Custer County, 62 percent of all businesses employ a Medicaid expansion enrollee who received job services through HELP-Link, which is a key part of Montana Medicaid expansion. In fact, every county is home to businesses employing Medicaid enrollees whose job search was bolstered by the the health care program. Fifty businesses in Fallon County, 151 in Richland County, 70 in Stillwater County and 55 in Sweet Grass County employ Medicaid expansion enrollees.


In our region, more than half of all employers in these counties have one or more workers covered by Medicaid expansion: Big Horn, Broadwater, Carbon, Fergus, Garfield, Golden Valley, Mussellshell, Park, Phillips, Prairie, Roosevelt, Rosebud, Valley, Wheatland and Yellowstone. These statistics were compiled by the Montana Department of Labor and Industry and analyzed by the Montana Budget & Policy Center.


Montana hospitals have agreed to help cover the state's 10 percent share of Medicaid expansion services. There will be very little net increase in Montana taxpayers' costs of caring for 96,000 enrollees — if the Senate approves HB658 as it is now written. That's because the federal government will pay 90 percent of Medicaid expansion care costs, compared with 65 percent of traditional Medicaid costs. (Without Medicaid expansion, some current enrollees would qualify for traditional Medicaid.) Also, Medicaid expansion covers some costs of inmate medical care that otherwise would have to be paid by the state or counties.


If you want your neighbors, your employees, your coworkers and your family to have access to the quality health care they need when they need it, please tell your state senator today. Leave a phone message at 406-444-4800 or go online to and clinic on "message a legislator". The situation is urgent, don't let Montana health care expire. Approve HB658. Read full story here.

MTN: Medicaid expansion bill advances to MT Senate floor

Mike Dennison
April 8, 2019

HELENA — On a 10-9 vote, a state Senate committee Monday advanced one of the 2019 Legislature’s biggest bills to the Senate floor: House Bill 658, which would continue Medicaid expansion, the $700 million-a-year program that provides medical coverage to 95,000 low-income Montanans.


Three Republicans joined all seven Democratic members of the Senate Finance and Claims Committee in support of the bill, which had been transferred the panel last Friday after it was tied up in another committee.


HB658 will be on the Senate floor later this week, where it’s expected to pass and continue on a path to the desk of Democratic Gov. Steve Bullock, who has indicated that he supports it.


Medicaid expansion provides government-funded coverage to adults ages 19-64 and who earn up to 138 percent of the federal poverty level, or about $17,200 a year for a single person. The federal government pays 90 percent of the program’s cost.


The program began in Montana in 2016, but has a June 30 expiration date unless the Legislature reauthorizes it.


HB658 would erase that expiration date, but adds some additional eligibility requirements for the program — including 80 hours a month of “community engagement,” which could be a job, volunteer work, or other activities. However, supporters of the bill have said large sectors of the covered population would be exempt from that requirement.


Whether to continue Medicaid expansion started the session as perhaps the biggest issue of the 2019 Legislature, but now appears to be resolved. The House approved HB658 on March 30 on a 61-37 vote and the Senate also is expected to approve the bill.


Before approving the measure Monday, the Senate Finance and Claims Committee amended it, removing a new tax on workers’ compensation insurance for businesses covered by the Montana State Fund. To make up for the lost revenue, the amendment also increased a tax on hospital outpatient services from 0.825 percent 0.9 percent.


Sen. Bob Keenan, R-Bigfork, who voted “no” on the bill Monday, said he recognizes the good things the bill has done for Native Americans’ health care, but that he felt opponents of the bill have been prevented from adding any amendments they believed would improve the program.


Yet Senate Minority Leader Jon Sesso, D-Butte, said Democrats and supporters of the program had made many concessions in HB658, and that he felt the process had been fair and open.


Last Friday, Republicans on the Senate Public Health Committee voted to table HB658. Hours later, the full Senate transferred the bill to the Senate Finance and Claims Committee, which had a hearing on the finances of the bill Monday morning.


Republican Sens. Mike Cuffe of Eureka, Duane Ankney of Colstrip and Dan Salomon of Ronan voted with the seven Democrats on the Finance and Claims Committee to approve HB658 on Monday. Full story here.

Missoulian: Medicaid helps close gaps in care for veterans

Apr 5, 2019 
Jill Bonny

As the daughter of a U.S. Marine Corps veteran and the director of Veteran Services at the Poverello Center, I have been surrounded by military service members my whole life. Through personal and professional experience, I know that not all former service members come back home to stable jobs, consistent paychecks, or a ready-made support system within their families and communities. Returning to civilian life after years of military service is a difficult transition — to say the least.


Jack came to the Poverello Center and enrolled in the Housing Montana Heroes transitional housing program for veterans experiencing homelessness. He was mentally broken when he arrived. He had been active duty in the military for several years, had seen, and experienced more than enough trauma. Because there were no services offered to him in the military to treat the symptoms of his trauma, he chose to self-medicate. Even though this man had served his country and risked his life for many years, he was only allowed a less than honorable discharge and was left with no benefits as a veteran. Luckily, he qualified for Medicaid and we could help him access mental health services.


Now Jack is doing well, he is actively accessing mental and physical health care, he is housed, and he has successfully had his discharge upgraded which has resulted in access to VA benefits. This would not have been possible without Medicaid. Jack’s access to mental health services was a vital piece in his accomplishments.


Comprehensive health care services are especially important for veterans because, like Jack, many of them suffer from unique, and sometimes serious or complicated, health issues as a result of their time serving our country.


Even though our country has made a commitment to care for our veterans by providing them with comprehensive health coverage through the Veterans Health Administration (VA), many people don’t know that not all veterans are eligible to receive health insurance through the VA. And even those who are eligible may not always be able to access care. Thirty percent of the homeless veterans we serve at the Poverello Center in the veteran transitional housing programs do not qualify for health care or mental health care benefits through the VA.


As a state, if we want to genuinely commit to doing everything we can for our veterans, we need to commit to continuing Medicaid expansion. My colleagues and I attended the Medicaid expansion bill hearings for House Bill 425 and House Bill 658 in March. We supported Rep. Mary Caferro’s bill, HB 425, but it was tabled in the House Human Services Committee.


HB 658, sponsored by Rep Buttrey, was amended in the same committee. I support the amended HB 658 because it contains language that will exempt those that are working or face barriers to work from new reporting requirements. Montanans who face chronic homelessness — like those we serve in transitional housing — will be exempt from the bill’s requirements. This will allow those who served and are struggling with serious health issues to focus on getting healthy and housed rather than worrying about filling out complicated paperwork.


All veterans should have access to quality, affordable health care. No veteran should ever fall through the cracks. One of the best ways Montana can make sure that’s true for our veterans is to continue Medicaid expansion. I urge Montana's state Senators to vote in favor of this bipartisan solution and continue a program that is working for our state and our veterans.


Jill Bonny is director of Veteran Services at the Poverello Center in Missoula. 


Full article here.

Billings Gazette opinion: What Medicaid expansion did for Park County

April 4, 2019
Billings Gazette Editorial Board

LIVINGSTON — In the windswept Yellowstone River town of Livingston, there's just one hospital to serve the county that stretches from Cooke City to the Crazy Mountains. Among Park County's 17,000 residents, 1,500 (9.5 percent) are covered by Montana Medicaid expansion. Besides providing access to quality, affordable health care for those 1,500 adults, the program has benefited the entire community.


"It's really helped those who are working," said Deb Anczak, Livingston Healthcare chief executive officer. "Fifty-eight percent of Park County businesses have (Medicaid expansion) enrolled employees." Statewide, more than half of all businesses have at least one employee who has been covered by the program, according to a Montana Department of Labor and Industry report.


"What it allows people to do is seek care at the appropriate time," Anczak told The Gazette on a recent visit to Livingston Healthcare, an affiliate of Billings Clinic. For Park County, Anczak said, Medicaid expansion resulted in:


  • More people getting preventive health care, such as mammograms and other cancer screenings.

  • The hospital and clinic adding jobs.

  • Hiring a psychiatrist and mental health nurse.

  • A clinic staff member training to become an addiction treatment counselor.

  • A 10-percentage point reduction in the proportion of uninsured patients. The uninsured used to be 16 percent of patients, now the uninsured are only about 6 percent.

  • A 20-percent reduction in uncompensated care.


"We're able to take that and reinvest in health care," Anczak said. Thanks to the reduction in bad debt and charity care because of Medicaid expansion, the entire community has local access to outpatient psychiatric care that is integrated with primary care.


When Medicaid expansion became available, Livingston Healthcare staff worked hard to get eligible Montanans enrolled. Many Park County residents have multiple jobs and seasonal employment connected to tourism and outdoor recreation — jobs that often don't offer year-round health coverage.


"We educate new patients about options for coverage," Anczak said.


Medicare remains the biggest payer for Livingston Healthcare at 46.33 percent of revenue, followed by Medicaid at 17.6 percent (including traditional and expansion programs) and about 4 percent self-pay. The remainder is private insurance.


One hundred thirteen babies were born at Livingston Healthcare in 2018, including 52 covered by Medicaid. Before Montana Medicaid expansion in 2016, few of those infants' mothers would have qualified for coverage until they were pregnant and their coverage would have ceased just a few weeks after delivery. With Medicaid expansion making all very low income Montanans eligible for coverage, most of those 52 moms were eligible for Medicaid coverage to keep them healthy before, during and after the pregnancy.


That's just one of many ways continuous coverage helps Montana families. Communities large and small across our great state have stories like Livingston: Medicaid expansion has covered workers who didn't previously have insurance, it covers otherwise uninsured parents, it boosts access to treatment for addiction and mental illnesses.


Despite the overwhelming evidence of the program's success in Montana, its future beyond June 30 is uncertain. The House last week approved HB658, a Republican plan to continue Medicaid expansion — with the addition of administrative costs and complexities for enrollees. Despite its shortcomings, HB658 must pass. It is the only path left for keeping most of 96,000 Montanans covered.


The bill now is in the Senate. Please encourage your senator to support HB658 to continue Medicaid expansion. Messages may be left by phoning 406-444-4800 or by going to and clicking on the bar that says "message a legislator."

Full article here.

MTN News: MT House gives final approval to bill continuing Medicaid expansion in Montana

March 30, 2019
Mike Dennison


HELENA — The Montana House Saturday gave its final approval to the bill continuing Medicaid expansion, which provides health coverage to 96,000 low-income adults in the state.


The House approved House Bill 658 on a 61-37 vote, sending it on to the Senate — where it’s expected to pass.


Support came from the same coalition of Democrats and moderate Republicans who voted Friday to advance the measure to its final vote.


Medicaid expansion, which began in January 2016, expires this June unless the Legislature reauthorizes it. It offers government-funded health coverage to adults earning up to 138 percent of the federal poverty level, or about $17,200 a year for a single person. The federal government pays 90 percent of the $700 million-a-year program.


HB658, sponsored by Rep. Ed Buttrey, R-Great Falls, continues the program but makes some changes, such as requiring some participants to log at least 80 hours of “community engagement,” which could be a job, job training, volunteer work, a full-time student, or a drug-treatment program.


The bill also includes several taxes to help finance the state share of the costs, including a 0.875 percent tax on Montana hospitals’ outpatient services. That tax generates $15 million a year for the state, but also generates another $100 million in federal matching funds for the hospitals, which they say is needed to help cover the cost of treating Medicaid patients.

Full story can be viewed here.

Lee Newspapers: Thanks to Montana legislators for supporting Medicaid expansion

March 29, 2019


This week, our Republican and Democratic state legislators notched a victory for Montanans. Working together with the governor's office, they agreed on legislation that would permanently reauthorize Medicaid expansion. This is good news for Montana, and a triumph for bipartisanship.


Republicans and Democrats were able to find common ground on this issue because both parties recognize that Medicaid expansion works for Montana. Since its passage in 2015, the Montana HELP Act has provided affordable health care to more than 96,000 working Montanans. As part of that program, over 25,000 Montanans have enrolled in workforce training programs to help them get back to work. And as a result, Montana has seen a 6 percent reduction in the number of previously disabled Montanans that have rejoined the workforce.


Having access to affordable health care means that Montanans get the preventative services we know save lives. Through the HELP Act, almost 8,200 women have received breast cancer screening, leading to an earlier diagnosis for 114 of them. Add to that over 7,000 Montanans screened for colon cancer, and almost 1,000 Montanans diagnosed and treated for diabetes. Medicaid expansion has also provided mental health services to 32,000 Montanans, and substance abuse services to over 8,000.

Our legislators deserve credit for finding a health care solution that works for Montanans. As a physician, I want to express my sincere thanks for their hard work in forging legislation that makes financial sense for the state and keeps our workforce healthy and strong.


Jason Cohen, MD, is a practicing hospitalist at North Valley Clinic in Whitefish.

Full article here.

New Study Released Analyzing Economic Impact of Medicaid Expansion in Montana

March 26, 2019
New Economic Impact Numbers: Medicaid Expansion Fuels 9,715 new jobs and $793 million in associated wages


(Helena, Mont.) – A new study released today by the Montana Hospital Association shows Montana’s Medicaid expansion is outpacing other states in Medicaid expansion performance and that Medicaid expansion has resulted in a much higher economic impact than previously studied.


The study was conducted by Navigant Consulting, Inc., a nonpartisan, global professional services company that works with Medicaid programs across the country.

When compared to eight peer states in the West that have and have not expanded Medicaid, the new study shows Montana had one of the lowest Medicaid expenditures as a percentage of State General Funds andone of the highest percentages of working adult Medicaid beneficiaries. 


The analysis shows that, between FY 2016 – FY 2018, Medicaid expansion led to over $2 billion in total additional economic activity and created or supported approximately 9,715 new jobs fueling $793 million in associated wages. According to the Montana Hospital Association, since Medicaid expansion, Montana’s uninsured rate has dropped by 48%, hospital rates have stabilized, and Montana’s nationwide health status is at its highest rank in more than a decade.

“Montana Medicaid works by creating approximately 9,715 new jobs and $793 million in associated wages and has positioned our state to be a more desirable place to live, work and do business. The new results from Navigant clearly document that Medicaid expansion has improved the health of Montanans and strengthened our business community. We hope legislative leaders recognize this significant economic contribution as they debate the future of Medicaid expansion in Montana,” said Rich Rasmussen, Montana Hospital Association CEO.


“Navigant works with Medicaid programs across the country,” said Navigant Associate Director Roshni Arora, lead author of the study, Analysis of the Impact of Medicaid Expansion in Montana. “Through our analysis, we identified significant economic benefit and increased use of critical healthcare services as a result of Medicaid expansion in Montana.”

“Medicaid expansion has been a game changer in Montana by significantly increasing access to life-saving preventive care. This new research supports what we see in the health care setting, that Medicaid expansion effectively shifts costs from more expensive and less effective treatment of health emergencies to more cost-effective, preventive care by catching health issues at earlier stages,” said Dr. Shelly Harkins, Chief Medical Officer at St. Peter’s Health.

Navigant estimates the annual economic impact of Medicaid expansion for 2019 and beyond will be:

  • Nearly $600 million in additional gross domestic product 

  • Over 9,000 jobs supported

  • Approximately $400 million in additional wages


Navigant has nonpartisan credentials providing assistance to both Republican and Democratic administrations, and frequently present for associations such as the Healthcare Financial Management Association and the Republican Lieutenant Governors Association. 


You can view the full report online HERE.

KTVQ: Hospital-funded Study: Medicaid expansion has huge economic, health impact in Montana

March 26, 2019
Mike Dennison

HELENA — Montana’s Medicaid expansion, which covers 96,000 low-income adults, has had a huge economic and health-care impact on the state, creating thousands of jobs and greatly lowering the number of uninsured people, says a study released Tuesday by Montana hospitals.


The study, released hours before a House committee planned to vote on bills to continue the Medicaid program, also compared Montana’s program and health impacts to neighboring states, including those that have not expanded Medicaid to cover poor, able-bodied adults.


“Medicaid expansion is improving health outcomes, creating a healthier workforce and saving Montana businesses millions in health-care costs,” said Rich Rasmussen, president of MHA, the lobby group representing Montana hospitals. “Medicaid expansion is contributing to billions of dollars in positive economic activity in Montana and, in a nutshell, Montana Medicaid works.”


The study by Navigant, an international consulting firm, focused on the program’s first two-and-half years in Montana, from 2016 through mid-2018. Its findings include:


• The program spent $1.24 billion during that time period, with $693 million coming in the final full year of fiscal 2018. Of that total, the federal government covered $1.17 billion, leaving about $70 million to be covered by the state and premiums paid by some of those covered.


• The expansion has led to an additional $2 billion of economic activity in Montana, using a common economic multiplier effect. It supported or created an additional 9,700 jobs during that time period and nearly $800 million of associated wages.


• About 84 percent of Montana private-sector workers have at least one co-worker who was covered by expanded Medicaid in 2017.


• In fiscal 2017, about 8 percent of Montana’s population was covered by Medicaid expansion — about the same as Washington and Colorado, but less than Oregon (10.8 percent) and more than North Dakota (2.7 percent). South Dakota, Wyoming and Utah did not have expanded Medicaid that year.


• Montana’s rate of people without health insurance dropped 56 percent from 2013 to 2016, in large part because of Medicaid expansion. The only other state in the region with a higher percentage drop was Oregon, at 58 percent.


• Montana hospitals saw a $270 million increase in Medicaid net-patient revenue from 2015 to 2017.



Roshni Arora, Navigant’s lead researcher for the study, said Medicaid expansion also has had a “very positive impact” on Montanans’ access to health care, leading to an increase in the use of prevention services, diagnoses of chronic diseases like diabetes, and treatment of substance-use disorders.


The Montana Legislature voted in 2015 to expand Medicaid, but the program is set to expire this June, unless lawmakers vote to extend it.


The House Human Services Committee planned to vote late Tuesday on a pair of bills to continue the program.


One of those bills — House Bill 658, sponsored by Rep. Ed Buttrey, R-Great Falls — would add some restrictions to eligibility for the program.


Rasmussen said hospitals, which are supporting both bills, hope that lawmakers will extend the program with “minimal disruption to our patients.”


“We’re hopeful that what they advance forward, in a bipartisan way, will provide minimal risk to anyone who is in the program today,” he said.

Full story online here.

Helena Independent Record: Medicaid expansion enabled Shodair to expand much needed services

March 19, 2019
Craig Aasved, Shodair Hospital


Every day, our team at Shodair hears that more services in psychiatric care are needed for children across Montana. Medicaid expansion allowed services at Shodair Children’s Hospital to broaden the reach extensively and improved the lives of Montana’s children and their families.


Thanks to Medicaid expansion, Shodair’s bed capacity increased 28 percent and allowed increased opportunity for children in crisis to receive lifesaving care. It also provided necessary funding for 32 direct care positions and a 2 percent raise for direct-care staff hospital-wide.


What is important to note is that funding for Medicaid expansion primarily comes from working Montanans who pay a monthly stipend for their health care coverage. This is not a program that is provided at no cost to recipients. In fact, seven out of 10 participants of Medicaid expansion are employed and the majority of the remaining 30 percent have disabilities preventing them from gaining employment.


Caring for Montana families, regardless of ability to cover the costs, was stitched into the fabric of our mission more than a century ago and today we remain committed to that line of thinking. Last year, 73 percent of patients treated at Shodair were on Medicaid and all but 1 percent are from Montana.


We know that children with mental health issues in Montana face many challenges, including access to professionals, transportation and support. At Shodair, we strive to eliminate financial barriers by serving patients regardless of their ability to pay. Six million dollars of free care was provided to Montana families who are economically disadvantage last year alone.


Our community of professionals continue to find ways to provide care to some of Montana’s most vulnerable residents. One benefit of Medicaid expansion is extended telemedicine services to patients across the state so they can receive care and treatment without the cost and hardship of having to travel. By using video conferencing technology, our mental health professionals are treating children with mental health issues every single day. Their care and commitments continues to inspire me.


Shodair employees respond the same way when asked why they love their job. “The kids,” they say without hesitation. That dedication motivates our administrative team, as well as our board, to always be the driving force for decisions that are made to help improve the mental well-being of our community. Medicaid expansion is one critical component to ensure that work happens. I remain hopeful that our elected lawmakers will vote to in favor to continue Medicaid expansion because they believe in our work, can see our dedication and want the children in our state to flourish. Read full story here.

Billings Gazette: Keep health care policies that are working for Montana

March 14, 2019
Patrick Cobb, M.D.


With the Montana Legislature’s biennial session already well underway, one debate has risen above the rest as the most important issue facing our state: Medicaid expansion. Montana’s expansion of Medicaid under the Affordable Care Act has added tens of thousands of our friends and neighbors to insurance rolls, and given a significant boost to the state’s economy.


Unfortunately the current policy, which was put in place in 2015, is set to expire soon if our representatives in Helena don’t vote to continue it. For all the talk nationally about ways to reform the health care system in the United States, one of the most impactful things we can do immediately is to protect this important program that has already helped so many.


Health care in this country needs changes, and there are many opinions on both sides of the aisle regarding what those changes should look like. But the Affordable Care Act and Medicaid expansion are working. We have the proof, and we see it every day; uninsured rates are significantly down and more people are able to receive care and live healthy lives. To not continue this policy that has given so many more Montanans access would be a mistake with real consequences for families across our state.


In Montana and nationally, it’s critical that we protect these reforms which are working, like the ACA and Medicaid expansion, rather than throwing the baby out with the bathwater to start from scratch. There are changes that can and should be made to bring down costs and expand access to coverage, but that shouldn’t come at the expense of the progress that has already been made.


By building on what we have today, we can maintain the coverage that so many people already enjoy, while continuing to provide patients with more options and eliminate barriers to receiving care that currently exist. Read full letter here.

Helena Independent Record: Local health board backs Medicaid expansion

Mar 11, 2019
Jim Benish, City-County Board of Health chair, and board members Wilmot Collins, Jenny Eck, Andy Hunthausen, Justin Murgel, Dr. Adron Medley, Kammy Johnson, Tyler Ream and Scott St. Clair.

The Lewis and Clark City-County Board of Health strongly supports House Bill 425, to continue Medicaid expansion in Montana in its current form.


Since the Legislature approved Medicaid expansion in 2015, the program has proved its worth. It’s opened the door to health care for almost 96,000 low-income Montanans, giving them an incentive to seek preventive care and reduce costly visits to the emergency room. It’s substantially benefited the state’s economy and job growth, and it’s even reduced crime, according to economic researchers at the University of Montana.


Here in Lewis and Clark County, more than 5,600 people have enrolled in Medicaid expansion. That’s 8.6 percent of our neighbors who stand to lose health care if the Legislature doesn’t pass HB 425.


What are these county residents doing with their newfound coverage? According to the state health department, almost 2,500 of them got treatment for mental health disorders. More than 700 got treatment for substance use issues, and almost 1,000 were screened for breast and/or colorectal cancer.



We believe everyone should have the opportunity to be healthy. Not only does good health benefit the individual, it benefits all of us. Healthy people are able to pursue education and play a productive role in the workforce and community affairs.


We’re becoming a better place to live because of Medicaid expansion. Join us in urging the Legislature to keep up this encouraging momentum.

Read full article here.


Missoulian: Medicaid expansion works as is

Mar 10, 2019 


We at Holy Spirit Episcopal Church, drawing on our religious traditions, scripture and the ministry and example of Jesus, support continuing Medicaid expansion to care for those who simply cannot afford other health care. Former Archbishop of Cape Town, South Africa, Desmond Tutu, once said, “…the good news to a hungry person is bread.” He could just as well have said that the good news to a sick -person is health care. Jesus' ministry was filled with healing the sick. He cured them — gave them back their health, renewed life and restored place in the community. He told us to do likewise.


Medicaid expansion in Montana will expire in June unless continued by the State Legislature. Few people have anything but praise for this program. Some 95,000 Montanans have coverage they didn't have before. They receive medical care sooner, which many recipients say has improved their health. Medicaid Expansion also offers outpatient mental health and substance abuse treatment for addiction and depression, which is expected to reduce the number of those needing costlier residential and inpatient treatment. Medicaid Expansion is a lifeline for both rural Montanans and the hospitals that serve them, with some 6,000 jobs added in the medical field alone. The state's economy has greatly benefited from $600 million in additional income.


Some legislators want to put work and reporting requirements in place as the price for making Medicaid expansion permanent. In Kentucky, they have budgeted $187 million to cover the cost of implementing and tracking work and reporting requirements. We believe it is better stewardship to spend precious dollars directly on those in need. It is estimated that between 31,000 and 43,000 Montanans with health care coverage under Medicaid expansion could lose it, as projected by the non-partisan Montana Healthcare Foundation, if work and reporting requirements are instituted. In Arkansas, the first state to put in place such requirements, nearly 17,000 people lost coverage from Medicaid expansion because they couldn't find work, couldn't navigate the complicated online reporting system, couldn't get access to a computer, or didn't even know such reporting was required. If Arkansas people fail to find work or report it correctly, they are removed from Medicaid and can't re-enroll until the following January.



Are you aware that most people covered by Medicaid expansion in Montana already work? Two-thirds of those who can work do, and, of those not working, 37 percent are sick or disabled, 33 percent are taking care of children or elderly family members and 18 percent are in school. The fact is that those at the poverty line must work multiple jobs because most jobs don't pay a livable wage. Indeed, those with Medicaid expansion coverage have little time in their lives for anything but work. And far from being a hand-up, work requirements could eliminate their health care — making it even harder for them to work and cope. Why add the burden of work on the third who for good reason are not able to be employed?


Please contact your legislators ( and ask them to put Medicaid Expansion on a permanent footing as is, without costly work and reporting requirements. The first legislative hearing on HB 425 is on March 16, before the House Human Services Committee.

Read full article here.

Bozeman Daily Chronicle Letter to the Editor: Medicaid expansion a must for mental health crisis

March 1, 2019 
By Katee Orr, Bozeman


It’s no secret that Montana is facing a mental health crisis. We have consistently ranked among the five states with the highest suicide rates, with our rate being almost double the national average. While it’s difficult to pin down a single root cause, we know that a serious contributing factor is that thousands of Montanans can’t afford vital mental health treatment.


Medicaid expansion has proved essential to combating this issue by opening up access to mental health treatment for the one in 10 Montanans enrolled in the program. This has had the dual benefit of expanding access to care and bringing in crucial federal funding to mental health treatment facilities across the state.


One of those facilities is Shodair Hospital, which serves Montana’s youth battling mental illness. Shodair is the only public facility in the state to provide acute and residential psychiatric treatment for our most vulnerable population. Their state-of-the-art holistic health care practice would be compromised if Medicaid expansion expires.


If we let Medicaid expansion expire in June, we’ll have crippled mental health services across the state, stripping thousands of Montanans of the care they need. The Legislature needs to do what’s right and lift the sunset on Medicaid expansion. Read full article here.

Missoulian Guest column: Medicaid expansion is important for veterans

February 27, 2019 
Ezra Davis

Ezra Davis is a case manager at Valor House, the Poverello Center's long-term transitional housing program for veterans, and is a veteran himself.


I served our country from 2001 to 2005 as a member of the United States Army. During this time I spent a year in Iraq serving in the Headquarters unit of 1-8th Infantry out of Fort Carson, Colorado. Following my service, I became involved with veterans advocacy, but was unfulfilled with the results I was seeing. Seeking something with more tangible measures of success, I became employed as the case manager at the Poverello Center’s Valor House transitional housing program for veterans who are experiencing homelessness.


Sam is one of 17 veterans currently staying with us at the Valor House. He arrived at the Poverello Center last spring after being unsheltered for over a year in a rural community in western Montana. Due to his veteran status, we were able to get him into an apartment at the Valor House.


Sam is a combat veteran who served during Operation Iraqi Freedom but, unlike myself, he does not qualify for Veterans Administration benefits due to a negative discharge he received as a result of persistent mental health symptomatology. While serving, instead of facing the stigma of seeking out a mental health care professional, Sam chose to remain quiet and not disclose the difficulties he was having. Although Sam’s mental health condition predates his military service, combat-related trauma clearly exacerbated his mental health condition. Receiving a discharge upgrade would allow Sam to receive benefits. This seemingly practical solution may take years and is not as accessible as it may seem at first glance. Mental health diagnoses made in childhood, along with scant mental health records regarding his combat experience, make for major hurdles to Sam’s discharge upgrade.


Sam is not the only veteran we serve who does not receive VA healthcare benefits. About 30 percent of the veterans served through the Poverello Center programs are not eligible for VA healthcare benefits. To receive care through the VA, veterans must meet certain criteria in terms of time served, disability and income. For example, many service members after 1980 served less than two full years, and therefore, are ineligible for VA care. Other examples include Reserve or National Guard veterans who do not qualify for VA benefits because they do not meet deployment requirements as an active duty service member, despite serving loyally for years.


Medicaid expansion has given Sam the opportunity to be one of the 7,000 veterans in Montana able to get healthcare. Through Medicaid, Sam receives dental care, which is generally not available to most veterans, even for those who receive VA healthcare. Sam’s holistic care offered through Medicaid has stabilized him enough to begin to look for permanent housing.


If Medicaid expansion is rolled back, or if onerous work requirements are added to the program, it could have devastating consequences for Sam and the 7,000 veterans who now receive healthcare through Medicaid. In the future, Sam may be able to work again, but right now his mental health stability requires his full-time focus. If he loses Medicaid, either because of a rollback or because of a work requirement, his progress will be stalled and he will likely continue his cycle of homelessness.


I work daily to make sure that every person who served our country, whether voluntarily or as a draftee, has a stable, safe and warm place to live. No one should be without secure housing, especially our veterans. I am asking our elected officials in Helena to help make this fight a little easier. Help me move Sam out of homelessness by doing the right thing: renew Medicaid expansion and refuse to make changes to the program that would hurt our veterans in Montana. Read more here.

Associated Press: Medicaid expansion bill would allow self-reporting of work

February 26, 2019
Amy Beth Hanson

(Helena, Mont.) - A Republican lawmaker who wants most Medicaid expansion recipients to work or attend job training has updated his draft bill to ease reporting requirements after an analysis predicted tens of thousands of people could lose their coverage by failing to meet the reporting terms.


Democrats are criticizing Republican Rep. Ed Buttrey's proposal to nix coverage for those who do not complete 80 hours per month of work, job training or searching, education, volunteer work or mental health treatment, with some exemptions.


His initial bill called for the state to track their compliance every three months.


A new draft of Buttrey's proposal would instead allow people to self-report their work, volunteer or other "community engagement" hours by phone, in writing or electronically. His measure proposes the state verify a percentage of those reports.


Democratic Rep. Mary Caferro, who is sponsoring a bill to continue Montana's Medicaid expansion program substantially as it is, said Tuesday the work requirement is a bad policy and isn't cost-effective. About 3,700 out of 96,000 people covered under Medicaid expansion aren't working, the state has said.


Caferro's bill would continue Montana's voluntary job training program for Medicaid expansion recipients, which supporters have said is being considered by other states.


Buttrey and Caferro co-sponsored the initial Medicaid expansion law in 2015. The program ends on June 30 if lawmakers can't reach an agreement.


Their separate measures this session both include a fee of just under 1 percent of hospitals' revenue for outpatient services to help support the program. The hospitals agreed to the fee in exchange for a higher reimbursement rate for services provided to Medicaid recipients.


Buttrey's latest proposal would require the Montana State Fund, the quasi-governmental workers' compensation program, to pay a 2.75 percent premium tax. It also would limit coverage to U.S. citizens and people who are legally in the country and who are considered Montana residents.


Caferro said the bills are scheduled for a hearing on Saturday, March 16 — a week later than was initially planned. Read full story in the Helena Independent Record here.

Helena Independent Record: Proposed Medicaid changes would hurt ag workers

By Kate Clyatt, Letter to the Editor
February 26, 2019


I work seasonally on ranches outside of Helena. My employers are unable to offer insurance, so I enrolled in Medicaid to make sure I have health care. Working with horses, cattle and heavy equipment includes substantial risk – I wanted to make sure I’d be OK if I got into a bad accident. Jobs in ranching are cornerstones of Montana’s way of life. Medicaid enrollees like me should not be subjected to work and online reporting requirements.


Ranching is a solid, honest job, but it can also have volatile hours and varying seasonal durations that make us eligible one month and short the next. These jobs also don’t have sick leave, so when workers get sick or have a family emergency, we risk losing coverage.


On the ranch, access to the internet or computers can be limited, so I definitely can’t submit online reports on what hours I have worked. I want my government to spend tax dollars on something useful – not more paperwork and bureaucracy. Any work requirement added to Medicaid expansion would have the unintended consequence of taking coverage away from people like me who are contributing to Montana's agricultural industry.

Read full letter here.

Flathead Beacon Letter to the Editor: Ditch Punitive Changes to Medicaid Expansion

February 22, 2019

By Whitney Pratt, Whitefish


I’ve been working on farms in the Flathead for four years. Working in agriculture, I have never been offered health care through my employer. The farm owners I worked for most recently did encourage all their farmhands to apply for Medicaid or health care through the Affordable Care Act if they don’t already have health insurance. They have in the past paid for tetanus shots out of their pocket for employees and help them navigate the system to secure affordable health care. This is unusual in part-time/seasonal work. Most employers can’t afford to help pay for their employees’ health care needs or help them secure their own health care.

Medicaid expansion has provided me valuable health coverage while I have been farming and working seasonally. Through my Medicaid coverage, I was able to cover the gap between my prior health insurance through an AmeriCorps program and the coverage I later received through the ACA. I was able to have regular checkups that I would have otherwise skipped and I was able to afford the physical therapy visits I needed in recovering from a shoulder injury. I ask my Montana legislators to continue Medicaid expansion. Health coverage is so important, especially for those of us whose physical health is necessary for our work and who work outside, seasonally, and in more rural areas of the state. I am proud of what I do for a living. I love it. And I need to be healthy and strong to do it. I don’t want to be punished for my work that doesn’t offer insurance coverage. Work and reporting requirements will only kick people off of their health care and leave seasonal workers with less financially certain futures. Keep Medicaid expansion – ditch the punitive changes that would only hurt workers like me. Full letter here.

Sidney Herald: Sidney Health Center officials stress need for Medicaid Expansion in Montana

February 19, 2019
By Bill Vander Weele Sidney Herald 

(Sidney, Mont.) - With Medicaid Expansion anticipated to be one of the hottest topics during this year’s Montana Legislature session, the Sidney Health Center has stressed the importance of the program by submitting a resolution to legislators.


The resolution, signed by Sidney Health Center’s board of trustees, notes that the HELP (Montana Health and Economic Livelihood Parnership) Act has benefitted more than 95,000 Montanans who have received health care coverage as of Oct. 1, 2018. The figure is 9.3 percent of Montana’s population. The information is based on a study by the University of Montana


The resolution also states that Medicaid Expansion has led to 7,026 women receiving breast cancer screenings and providing 28,683 patients with outpatient mental health services.


Montana has seen uninsured rates reduced by 48 percent during this time.


Jen Doty, CEO of Sidney Health Center, said, “Because of the expansion, people have access to health care and are using it. It has improved and enhanced access.”


Doty notes that there are 648 residents enrolled in Richland County. Of that number, 76 have undergone breast cancer screenings, 45 have went througn colon cancer screenings, there were 186 mental health outpatient cases and 660 received preventive services. 


She explained that these patients are individiuals who don’t quality for regular Medicaid because their incomes are too high, but they can’t afford to pay for traditional health insurance.


“Expansion makes it more afforable,” Doty said. She feels individuals also remain in the workforce because of expansion rather than be unemployed and receive regular Medicaid. “We don’t want them to quit working. They are now employed in our workforce.”


She explained that Sidney Health Center’s board of trustees created the resolution after the Montana Hospital Association requested all hospitals to urge legislators to repeal the sunset of the HELP Act, which is scheduled to sunset in June.


“This is right for all of us,” Doty said. She added that Sidney Health Center isn’t as impacted as other hospitals that have a higher percentage of Medicaid Expansion patients. “It’s still a big deal for us. We want to improve access to all people.”



While Montana’s Democrats wish to keep the program as is, Republicans are looking at different alternatives. One part of a Republican bill is to have a “community engagement” provision that would require work, volunteer hours or being involved in programs such as a substance use disorder treatment.


“I’m glad to hear what our Sidney Health Center thinks on this important issue as we discuss the various proposals being put forward,” State Rep. Joel Krautter, R-Sidney, said. “I understand having a safety net in our society, but do not want policy that promotes dependency.”


Krautter added, “I will be looking at what reforms can be made during the discussion. Making sure Montana’s budget is protected is critical, so I want to see triggers in place for any unforeseen federal funding changes.”


Doty said she doesn’t see the issue as a Republican or Democrat one but important to everybody.


“Our plea is that they repeal the sunset on it,” Doty said. “We want a healthy community. That’s our mission.”

Read full story here.

NBC Montana: Montana Hospital Association, rural hospitals lobby for Medicaid expansion

February 19th 2019
by Larisa Casillas


LIVINGSTON, Montana -- In Montana, the Medicaid expansion program is subject to expire this summer, making it one of the hotly debated issues this legislative session.


Livingston HealthCare is one rural hospital where they say the program has allowed them to keep their operations going and invest in other services.


According to hospital officials, the uninsured rate in the state went from about 20 percent to 7 percent with Medicaid expansion.


They say it's also led to more preventive care and less costly emergency room visits.


"If patients are self-pay patients they may delay care or not seek care at all and then get into a more crisis situation and not manage their chronic conditions and then end up in the emergency room, using that as their first point in contact," said Deb Anzack, CEO at Livingston HealthCare.


Anzack says 58 percent of businesses in Park County have one or more employees on expanded Medicaid.


Still, the Montana Hospital Association says it's not just rural hospitals that benefit.


"What Medicaid expansion has done is it has been one of the largest or single largest business subsidies by providing care for working Montanans. It has also helped to stabilize the rates in which private health insurers have been able to pass on," said MHA president Rich Rasmussen.


The association is lobbying this legislative session hoping to reach a bipartisan solution.


"It's going to take approximately $15 million a year to continue Medicaid expansion, and that is based on the fact that the program is now being funded 90 percent by the federal government and 10 percent by the state," said Rasmussen.


He says if a solution is not reached hospitals would have to decide which services to cut.


The deadline for the program to expire is in July. Full story here.

Missoula Current - Social workers: Montana cannot afford to end Medicaid expansion



Thousands of Montanans have chosen a career in social work to help individuals and families across this state in life-changing ways. The day in the life of a social worker changes every day and no two social workers in Montana have the same exact job description. But one thing is clear for all of us – we know how important health care access is.

As social workers, we are responsible for supporting and guiding individuals, families, and groups of people to cope with problems they’re facing. We work hard to help improve the quality of life for our patients. Some of us are advocates for children in the foster care system, and others work in the classroom to help kids with special emotional needs in school. Many are licensed addiction counselors who help individuals in their recovery from substance use disorders. We work in medical facilities to develop appropriate care plans for patients when they are discharged. Some of us help families figure out complex paperwork, to connect them with safe housing, financial assistance classes, and health care.


At the very core of our work – and what all social workers share regardless of specialization in childhood trauma or licensed addiction counseling – is a commitment to improving access to affordable health care. Medicaid expansion in Montana matters to us because it is critical to the people we serve. It has made a world of difference for individuals and families who could not otherwise afford health care coverage, were not covered by their employers to access health care services, or were ineligible for VA health care. When people can finally afford the care they need, they are more likely to be more stable individuals, better parents, stronger students, more consistent employees.


Montana cannot afford to end or change Medicaid expansion that would kick people off their insurance when they need it most. When parents lose access to needed health care and their physical and mental health needs go untreated, kids are worse off. Many of those who would lose coverage have serious health needs, so even temporary interruptions in treatment can lead to deterioration in health, increased emergency hospitalizations, and higher health costs. Medicaid expansion is a critically important tool for Montana to more effectively deliver and pay for behavioral health services.​


Social work is a dynamic, challenging, and satisfying profession that is committed to the empowerment of individuals, families, and communities and the promotion of a more just society. We don’t do it because it pays well. We do this work because we know that we are helping to meet the needs and protect the dignity of all people. At the end of the day, our work makes our communities better, stronger, and safer places to live for everyone.

We are on the front lines of health care access for Montanans. Our work may look different every single day, but one thing we all have in common is witnessing the profound benefits that Medicaid expansion as brought to our state – person by person, family by family.


We urge our legislators to continue Medicaid expansion as it is. It is working. It is helping people and our communities.

Ann Truesdell is the Executive Director of the National Association of Social Workers – Montana, a professional organization of social workers that works to enhance the professional growth and development of its members, to create and maintain professional standards, and to advance sound social policies with over 500 members in Montana. Read full article here.

Bozeman Daily Chronicle: Cutting health coverage would be mistake

February 17, 2019
Bozeman Daily Chronicle Editorial Board

Montana lawmakers are considering changes to the state’s Medicaid expansion that will strip health coverage from tens of thousands of Montanans. It would be a grave mistake if that happens.

Since lawmakers approved the Medicaid expansion four years ago, some 95,000 Montanans have enrolled. For many, it was the first time they had any kind of health coverage. The bipartisan legislation that enacted the expansion will sunset at the end of June unless lawmakers can reach a deal to keep it going.


Gov. Steve Bullock and fellow Democrats in the Legislature want to leave the program as is, while Republicans want more money to cover increased costs when the federal government’s 100 percent funding of the expansions decreases to 90 percent next year. They hope to do that with combination of fees collected from hospitals, increased premiums from beneficiaries and requiring those beneficiaries to work at least 80 hours a month.


An analysis from George Washington University’s Center for Health Policy Research of a draft of proposed changes to the program found that between 31,000 and 43,000 would lose coverage under those changes.

Taking coverage away from nearly half of those covered by the expansion is bad enough. But the benefits of the expansion extend far beyond those direct recipients.


A study by a pair of University of Montana researchers found that the expansion generates some $600 million annually for the state economy by creating more than 6,000 jobs and $350 million to $385 million in personal income a year – much of that in rural areas woefully underserved by health care services prior to the expansion. All of that new income generates new income tax collections for the state. Taking coverage from as many as 43,000 beneficiaries could cut those economic benefits nearly in half.


Also to be considered is that state hospitals’ $400 million in uncompensated health care has been halved by the expansion. And those hospitals – much to their credit – have agreed to pay some of those savings to help fund the expansion through a fee that will generate some $30 million.


It’s to be expected there will tweaks to the expansion program before enough lawmakers sign on to extend it for another two years. But that needs to happen without taking a step backward and booting beneficiaries off the program. Read full editorial here.

Missoulian Guest Editorial: No viable solution to address behavioral health crisis in our state without Medicaid expansion

Friday, February 15, 2019
This opinion is signed by Behavioral Health Alliance of Montana (BHAM) board members Jim Fitzgerald, Sydney Blair, Lenette Kosovich, Judith B. Herzog, Lenore Myers, Kathy Chavis, Bob Wigdorski, Julie Fleck, Dan Krause, Levi Anderson and members of BHAM.

Montana is in the midst of a substance use disorder and mental health crisis. The evidence is all around us, from the latest youth suicide report, increased homelessness in towns, increased involuntary commitments, or news of drug overdoses.

This is undoubtedly a complicated and urgent crisis, but it is not without solutions.

Our state is at a critical juncture to decide the future of Medicaid expansion. In addition to providing access to important physical health care services, Medicaid expansion has been an invaluable tool for Montana to provide unprecedented access to mental health and substance use disorder treatment services in the past three years.


Since Medicaid expansion passed, nearly 100,000 Montanans have gained access to health coverage. According to the Department of Health and Human Services, nearly 10,000 adults have received substance use outpatient or inpatient services and about 35,000 adults have been able to access mental health care services.


The Behavioral Health Alliance of Montana, with almost 30 mental health and substance use disorder treatment service providers, knows one of the most effective ways to respond to the epidemic is to make Medicaid expansion permanent. The HELP Act must be reauthorized to ensure that the people we treat have access to high-quality health care.

However, there are talks of changing this successful program that make us worried. The changes we are concerned about include unnecessary, strict reporting requirements in order to maintain coverage. Proposals to take health care away from people who do not meet stringent work and reporting requirements jeopardize Montana’s rural communities and Indian Country, where Medicaid is an important source of coverage to communities facing high barriers to care and unemployment rates. Mental health and substance use disorder treatment has already been drastically reduced in rural areas due to the statewide budget cuts last year.


The urgent need to make sure people have access to behavioral health care is real. Medicaid spending on substance use disorders has increased five-fold from 2015 to 2017, most of which is new federal funds, as more people are able to get the care they need. Expansion is the most cost-effective way that we can ensure Montanans have access to the help they need to manage mental health issues and to successfully recover from addiction.


Mental health and substance use disorder treatment service providers across the state have seen the life-changing impacts of Medicaid expansion. We will tell you time and time again that if Medicaid expansion were repealed or if the legislature imposed new, strict requirements on enrollees, that our state’s progress and ability to successfully meet the behavioral health needs of Montanans would be rolled back five to 10 years. In addition, many of the providers will be unable to keep their doors open as reimbursements has been severely reduced.


The people who work in this field every day — therapists, mental health providers, licensed addiction counselors and community service providers — will tell you the same thing: there is no viable solution to address the mental health and substance use crisis in our state without Medicaid expansion.


We call on legislators to make the right choice for Montana and the people we serve. Simply lift the sunset on a program that is working. Don’t punish Montanans because they need help. Giving them health care is the ticket to helping them live full lives and take part in our communities. It’s good for them, and it’s good for Montana. Read full column here.

Lee Newspapers: Medicaid expansion has changed the landscape for Native American health care

February 17, 2019


 (Helena, Mont.) - Todd Wilson has seen first-hand the positive feedback loop that comes from having more people who seek care at Leo Pocha Memorial Clinic walk in the door with health insurance.


In 2015, before Medicaid expansion in Montana started, about 80 percent of those who sought care through the Helena Indian Alliance facility did not have health insurance coverage.


Montana has historically had one of the highest rates of uninsured American Indians, reaching nearly 43 percent in 2009 before the passage of the Affordable Care Act.


But once the landmark health care law opened the pathway for states to expand Medicaid, which Montana did in 2016, Wilson saw a dramatic change. The percentage of uninsured people to insured almost flipped; now only 15-20 percent of patients at the Alliance don’t have coverage.


Most of that is attributable to Medicaid expansion, Wilson said. Out of the Alliance’s total Medicaid population, 91 percent are covered by the expansion program.


Treating more people who have health insurance has meant the clinic and other programs the Alliance runs, like mental health services and a substance use disorder treatment program, are able to get paid more for what they provide. And the money coming back is invested into providing more services.


“We saw a really big impact from it financially,” Wilson said of Medicaid expansion. “We were able to get all those individuals that fell within that 18-64 (age) demographic enrolled into the program so we’re able to bill for their services.”


If someone comes to the Alliance without health insurance, they pay for services on a sliding scale based on income. But when there’s insurance in place, the Alliance has somewhere to get reimbursed for the care it provides.


The dollar figures associated with that change show how much of a financial boost Medicaid expansion has been to the Alliance. In the 2015 fiscal year, it billed about $150,000 to third parties for services it provided. Now it’s about $850,000 a year.


“With that money, we’re able to increase our services and personnel,” Wilson said. “It’s really grown.”


The Alliance brought on nine new staff, adding positions ranging from administrative support to clinicians and counselors, Wilson said. It expanded into new areas of the clinic building that were previously shuttered.


The clinic is federally qualified, meaning anyone can get care there. Its substance use disorder program greatly helped expand the options for those services in Helena, Wilson said, and expansion has made it easier to get that treatment.


“Being able to hire more staff, we were able to eliminate that wait list (for substance use disorder treatment),” Wilson said.


When the Montana Legislature first passed Medicaid expansion in 2015, it extended Medicaid coverage for people ages 18-64 who earn up to 138 percent of the federal poverty level, or $15,418 a year for an individual or $26,347 for a family of three. The program is set to expire this summer unless legislators extend it. Read full story here.

Bozeman Daily Chronicle: Report: Republican plan could boot 43,000 off Medicaid expansion

February 13, 2019
By Katheryn Houghton Chronicle Staff Writer


If an early version of a Republican remake of Montana’s Medicaid expansion becomes law, up to 43,000 low-income people could lose health coverage, according to a new report.


The Center for Health Policy Research out of George Washington University released the report Wednesday. The findings state proposed work requirements and increased premiums would whittle how many people can use the health program that covers roughly 95,000 Montanans.


Lead author Leighton Ku said the report estimates between 31,000 and 43,000 Montanans would lose coverage.


“Many people likely to lose coverage are already working when they can or they live in rural areas and are unable to find a job,” Ku said.


Montana’s expansion is due to expire June 30. Many lawmakers have said they want a version of the program to continue, but there’s a split on what shape it should take.


Democrats have said the program works as is, for the most part. They point to more people signing up for the coverage than expected as evidence that the expansion, called the Help Act, is working.


Republicans have said the high enrollment is a symptom of people abusing the system.


Rep. Ed Buttrey, R-Great Falls, brought the first version of the program before lawmakers. Now he’s proposing what he’s called “Help Act 2.0.” As he’s said in the past, the proposal seeks to ensure enrolled people “have some skin in the game.”


Tuesday’s report is based on Buttrey’s draft legislation, which is not available online. Buttrey didn’t immediately return a request for an interview.


Called the Medicaid Reform and Integrity Act, the bill would require 19- to 59-year-old enrollees to work 80 hours a month or lose coverage after three months unless they have an exception, according to the report.


It would also raise the monthly premium recipients pay for the coverage.


That would further increase for those enrolled more than two years. Buttrey has said the program is intended as a short-term solution and people who rely on the expansion indefinitely contradict that.


Montana Gov. Steve Bullock released a statement following the report Wednesday in which he called the proposed changes damaging.

“We already have a successful bipartisan approach to Medicaid expansion that ensures healthy people are finding and keeping good jobs,” Bullock said. “It doesn’t make sense to me that we would abandon this approach all to spend more money, kick up to 43,000 Montanans off of their coverage, and hurt our rural hospitals.”


Full story here.

Bozeman Daily Chronicle: Medicaid expansion benefits economy, public safety
February 12, 2019
By Caitlin Borgmann Guest columnist


Medicaid expansion in Montana has helped one in 10 Montanans access health care, saved taxpayers money and generated jobs. Yet despite this well-documented success, the program’s future is not secure. First, the program is set to expire in June unless the Legislature renews it. Second, its effectiveness could be severely undermined by proposals to take coverage away from people who cannot meet onerous work and reporting requirements.

Most Montanans know about the health and economic benefits of this program. Less reported are the ways that Medicaid expansion enhances public safety. National statistics show that with Medicaid expansion, both violent and property crime rates fall. Some research has found that this is driven mostly by increasing access to mental health care and treatment for substance use disorders. The University of Montana Bureau of Business and Economic Research looked at a substantial body of research and found that on a national level, Medicaid expansion has “reduced crime, generating social benefits worth more than $10-13 billion annually.” Research from Michigan has shown that rates of recidivism fall by 46 percent when individuals have health care and social services.

One reason for this: Medicaid expansion decreases the burden on local services charged with keeping people safe. For example, when an uninsured individual’s mental health or substance use disorder turns into a crisis, providing emergency services puts a huge burden on limited local resources, including police and fire departments and emergency rooms. Increased access to care and the ability to act in a preventative manner when possible allows these vital services to prioritize public safety. Full column here.

Missoulian: Montana Medicaid expansion: What a good deal looks like for the economy and fight against cancer

February 12, 2019 
By Bill Underriner


As a business owner for the past 18 years in Billings, I know what a good deal looks like, and continuing Medicaid expansion is not just a good deal — it is a great deal.


Through my service on the national board of the American Cancer Society Cancer Action Network (ACS CAN), I also know we are making significant progress in addressing cancer incidence and mortality in Montana. Medicaid expansion has played a large role in that achievement by helping avert nearly 2,500 cases of colon cancer and providing more than 7,500 breast cancer screenings since January 2016.


In 2015, our state policymakers did the right thing for families and our communities by passing Medicaid expansion. After three years, the numbers speak for themselves — 95,000 Montanans now have access to affordable health coverage and that has helped spur hundreds of millions of dollars in economic activity in local economies.


Medicaid expansion is also good for business. Over 18,000 businesses have at least one worker who now has access to health care through Medicaid expansion. Medicaid has created good-paying jobs around the state and has injected over a billion dollars in federal funds into our state’s economy, helping to keep the doors of critical access hospitals open in Montana’s rural communities.


Policymakers must again do the right thing and preserve access to health care coverage for our friends, family and neighbors across the state. Medicaid expansion will sunset in June unless the Montana Legislature takes action in the coming weeks. Some legislators predict it will be extended because they are not likely to leave Montanans out in the cold. But, there are caveats that could be added that spell a public health disaster.


Some lawmakers are considering proposals that would condition a person’s eligibility for Medicaid on work or community engagement requirements. These new administrative reporting requirements will limit or restrict eligibility, significantly reducing and denying enrollees access to preventive and treatment services. Cancer patients, survivors and those facing a cancer diagnosis could be seriously disadvantaged and find themselves without Medicaid coverage because they are physically unable to comply with these new requirements.


Over the past few years, Montana has been a national leader in workforce development and meaningful job training programs for Medicaid enrollees. Rather that waste money on simply monitoring the hours of people who are already working and take coverage away from those who cannot work, Montana’s HELP-Link program invests in job training and workforce development programs. By addressing actual barriers to work, HELP-Link has been successfully connecting low-income Montanans to employment as well as higher-wage job opportunities. Read full column here.

Great Falls Tribune: Tribal leader urges state to continue Medicaid expansion

February 8, 2019
Phil Drake, Great Falls Tribune


HELENA — The head of the Fort Belknap Indian Community urged state lawmakers Thursday to continue Medicaid expansion, support legislative efforts to combat suicide and keep public focus on the murders of Native American women and children.

In a 30-minute state of tribal nations address to members of the House of Representatives and various other state officials, Andrew Werk Jr., president of the Fort Belknap Assiniboine Gros Ventre Tribes, told lawmakers that Native Americans have proven that they can manage buffalo on their own land. He called the slaughter of buffalo at Yellowstone “unacceptable.”

He said nearly 50,000 tribal members have health care through Medicaid expansion, which the Legislature and governor approved in 2015 and is set to sunset in late June.

There are now efforts between Republicans and Democrats to continue the program. Werk said the program was critical to American Indians and Montana’s health. “I urge the Montana Legislature to continue to support Medicaid expansion,” he said.

Werk was the latest in a line of officials who have spoken to the state Legislature since it convened Jan. 7. Full story here.

Associated Press: Montana hospitals agree to help fund Medicaid expansion

February 7, 2019
By Amy Beth Hanson



HELENA — Montana hospitals have agreed to pay a fee to help fund Medicaid expansion as the state's share of the cost of the health care coverage increases, an official with the Montana Hospital Association said Thursday.


Bob Olsen, the senior vice president for the MHA, said Gov. Steve Bullock and state lawmakers made it clear they expected industries that benefited from Medicaid expansion to help pay to continue it.


State officials have estimated that hospitals statewide saw their $400 million in uncompensated care drop by half as a result of Medicaid expansion, which covered 95,000 low-income adults on Dec. 1.


The MHA had hoped a referendum to increase tobacco taxes would raise the needed money, but when voters rejected Initiative 185 in November, the hospitals had to find another solution, Olsen said.


The proposal calls for hospitals to pay a fee of 0.95 percent of their outpatient revenue, which includes payments for tests and outpatient procedures, but not physician or other professional charges.



The fee is included in a bill Rep. Mary Caferro, D-Helena, released Thursday and a draft Medicaid expansion bill by Rep. Ed Buttrey, R-Great Falls.


It will generate an estimated $30 million over two years, with half funding Medicaid expansion and half helping to increase provider reimbursement rates for traditional Medicaid and the expansion program, Olsen said.


The fee will not be paid by state- or county-owned hospitals.


The state's cost of the Medicaid expansion program continues to increase as the federal share drops to 90 percent in 2020.


Continuing the program is one of the key issues for the 2019 Legislature and Buttrey has said he wants to do so without increasing the cost to taxpayers. Full story here.

Guest Column: ‘Work requirements’ threaten Medicaid expansion

February 6, 2019
By Mary Caferro
Guest Columnist 


What do rural hospitals, small businesses, and one in 10 Montanans have in common? They all benefit from Montana’s Medicaid expansion.


That’s why I’ve introduced the Keep Montana Healthy Act, which will continue a program that works well for the health of all Montanans.


During the 2015 legislative session, I proudly co-sponsored a bill that expanded health care coverage to one in 10 Montanans. Now, four years later, Medicaid expansion is firing on all cylinders.


Here’s what we know:


First and foremost, Montanans are healthier than ever. For breast cancer and colon cancer alone, more than 14,000 Montanans had access to cancer screenings that allowed for early detection and treatment because of Medicaid expansion.


Second, Montana Medicaid has provided a backbone for small businesses and generated hundreds of millions of dollars of economic activity for our state. What’s more? The program will save the state a projected $60 million by 2020.


Third, Montana’s Medicaid program created a bipartisan, highly successful workforce development program called HELP-Link that has helped Medicaid enrollees access workforce training and a path to higher wages. After Medicaid expansion went into effect, workforce participation from low-income Montanans increased by 9 percent. Within a year after receiving these services, 81 percent of the HELP-Link enrollees are employed, and 71 percent saw an increase in their paychecks.


And finally, we know Montana Medicaid has thrown a lifeline to our rural hospitals and empowered rural Montanans to seek preventative care. Since the Legislature passed Medicaid expansion in 2015, our state has not lost a single rural hospital.


There are no ifs, ands, or buts about it: Montana Medicaid expansion has been a good deal for our state. That’s why, during the first week of the 2019 legislative session, I brought forward the Keep Montana Healthy Act. Read more here.

Montana Public Radio: Medicaid Expansion Reduces Barriers, Improves Health Outcomes, Enrollees Say

February 4, 2019
By Kevin Trevellyan

A new survey suggests Montanans who enrolled in the state’s Medicaid expansion program are healthier, less likely to put off treatment and more able to access mental health and substance abuse care.


Forty-three percent of those who responded to the nonprofit Montana Healthcare Foundation’s survey said their general health has improved since joining the program. Nearly 70 percent reported improved access to medical care.


The survey results come as Montana’s Legislature debates extending Medicaid expansion. The 2015 law authorizing it expires at the end of June unless lawmakers continue it.


Montana Healthcare Foundation CEO Aaron Wernham says new data answers one of the debate’s key questions: is coverage benefitting people?


"When you see nearly 70 percent of people saying that their ability to now access needed services has improved, that’s evidence that the program is working as intended. Its giving people access to care and it’s improving health."


The foundation worked with the state to survey a representative sample of the roughly 95,000 Montanans enrolled in the program.


Wernham says one of the survey’s largest insights is that nearly half of respondents reported improved access to needed mental health and substance use treatment services.


Montana has the country’s highest suicide rate. State data also indicate 90 percent of Montanans with addiction issues aren’t currently in treatment.


What’s blocking their ability to get help?


"The answer to that question is clearly that one of the barriers was the ability to pay," Wernham says.


Sixty-four percent of survey respondents said that prior to receiving Medicaid coverage they waited to seek medical care. Nearly half took less medication than prescribed, due to the cost.

Read more here.

Great Falls Tribune: Another report touts benefits of Medicaid expansion
Jan. 29, 2019 
Phil Drake, Great Falls Tribune


HELENA — Medicaid expansion has brought more than $600 million each year into Montana’s economy, creating nearly 6,000 jobs and $350 million annually in personal income, according to a new report.


The report was released Monday as the state Legislature gets ready to deal with the Montana Health and Economic Livelihood Partnership Act (HELP), a program catered to Montana and created in 2015 to bring in federal Medicaid expansion.


It found that although Montana pays for a share of the coverage, the savings created by the program along with state revenue generated more than offset the cost to the state.


HELP requires enrollees to pay premiums and copays for services. It sunsets June 30, 2019, and continuing the program is expected to be one of the big issues this legislative session. There were 94,594 Montanans participating in the program as of November.


The analysis was conducted by the University of Montana’s Bureau of Business and Economic Research and ABMJ Consulting and was commissioned by Headwaters Foundation and the Montana Healthcare Foundation.


It follows findings of earlier reports released by other supporters of the HELP act.


The Montana Hospital Association noted the report also found it created as many as 7,500 jobs, brought a 1 percent increase in employment and income statewide, had a positive net impact on the state budget of $6.5 million, after factoring in new tax revenues generated as a result of Medicaid expansion.



The net fiscal impact on Montana’s budget is positive, the report claimed, even in 2020 when Montana will begin paying the maximum 10 percent share of the costs.


Full story in the Great Falls Tribune here.

Bozeman Daily Chronicle: Medicaid expansion continues to boost Montana economy

January 28, 2019

By Katheryn Houghton | Chronicle Staff


HELENA — Montana’s Medicaid expansion sends more than $600 million into the state a year, according to a new independent report. That dollar amount, higher than previous forecasts, arrives in the buildup to a debate in the state capitol over the program’s future.

The Montana Healthcare Foundation and the Headwaters Foundation commissioned the work and announced the report here on Monday.

“It’s really telling the same story to what we’ve already seen,” said Bryce Ward, a health economist with the University of Montana and ABMJ Consulting.

Ward wrote the report with Brandon Bridge of the University of Montana’s Bureau of Business and Economic Research.

Overall, the findings show that savings and revenue tied to expansion outpace the expected cost to the state.


The expansion spending helps Montana’s economy in two ways. First, the federal government picks up most of enrollees’ cost of care. Ward said that largely replaces what was once covered by the state, health providers or patients.

Second, it supports new health care spending. There’s roughly 96,000 Montanans with access to treatment who may otherwise have gone without care due to the price.

That ripples through Montana’s economy. The report estimates it creates between 5,900 and 7,500, jobs and $350-$385 million in personal income each year between 2018 and 2020. Continue reading full story in the Bozeman Daily Chronicle here.

Billings Gazette opinion: Keep Medicaid expansion in Montana as is

February 3, 2019
By The Billings Gazette Editorial Board

Excerpt: Nearly every legislator in Helena agrees: We need to keep Medicaid expansion in Montana. But not every legislator agrees how that should be done.

Nearly one in every 10 Montanans depends on Medicaid for dependable, affordable health care. Medicaid expansion has not only been a boon to individuals who now have access to a doctor in a non-emergency, non-catastrophic manner, but it has also been a blessing to employers who may not have been able to afford healthcare coverage to all staff. 

Most state lawmakers also realize that eliminating the program, which draws $600 million to the state, would damage the economy, and potentially leave Montanans who can't afford healthcare in dire shape.


Beyond agreeing that Medicaid should stay, though, there is plenty of debate about whether changes should be made to the program.


Many Democrats argue that few changes are needed because 1-in-10 Montanans using the program demonstrate it's working. Also, the percentage of covered Montanans with health insurance has also increased.


Meanwhile, Republicans want to see the program maintained, but want to put some other requirements on its eligibility, including an asset and means testing, a work requirement, and possible drug testing.


We have to wonder: Where's the proof it isn't working and more bureaucratic hoops need applying? After all, we see every evidence that it is working well. Nearly 100,000 Montanans now have reliable insurance. What's more is that the federal government picks up about 85 percent of the funds for the program, while Medicare, also a federal program, would only cover about 65 percent.

Read more in The Billings Gazette here.

Missoulian editorial: Busting 5 myths about Medicaid expansion

Feb 3, 2019 


Last week saw the release of a major bill draft on Medicaid expansion. Carried by Rep. Ed Buttrey, R-Great Falls, who also sponsored the original Medicaid expansion bill that passed the Legislature in 2015, this version would continue the program past its current June 30 sunset date, but also add new requirements for would-be enrollees.


Like any draft bill, this one is likely to undergo amendments as it makes its way through the Legislature. Meanwhile, Rep. Mary Caferro, D-Helena, has introduced a competing bill that would continue Medicaid expansion without any changes. Its chances are slimmer in the Republican-controlled chambers.


Unfortunately, the draft language of Buttrey’s bill hints that some persistent myths about Medicaid expansion are lingering in the Legislature, despite Montana’s clear success with the program since its implementation and recent reports that blow apart some of the worst misconceptions.


Here are five stubborn myths about Medicaid expansion that Montana’s legislators — and their constituents — ought to dispel right away, so that future discussions can be based on good information and proven facts.




Myth: If Medicaid expansion fails, enrollees will have to go out and get jobs.


Fact: Most people covered by Medicaid are already employed. The Montana Department of Labor and Industry, in a report released Jan. 8, found that 7 out of 10 Medicaid enrollees are working, and among those not working, 1 in 3 are ill or disabled. In 2017, this amounted to more than 80,000 individuals in Montana who were both employed and enrolled in Medicaid. The remaining population either worked out of their homes, were in school or were the primary caregiver for a family member.


In fact, only a scant 4 percent of Medicaid participants were unemployed for unknown reasons.


Myth: People on Medicaid are just lazy and don’t want to work.


Fact: The reality is that employment does not guarantee health coverage. Many Montana workers are either self-employed and unable to afford health insurance, work for an employer that does not provide health insurance, or work part-time and don’t qualify for full benefits. In fact, many Montanans work multiple part-time jobs in order to make ends meet. Another Department of Labor and Industry report calculated that “the average job in Montana had a work week of only 32.8 hours in 2014 — the shortest work week in the nation.”


To qualify for Medicaid expansion, an individual must earn less than 138 of the federal poverty level, which is $15,418 a year. For a family of four, it’s $25,100.


The current version of Buttrey’s bill proposes to require enrollees to report at least 80 hours of work each month. Those who can’t work would be required to show they are actively seeking a job, enrolled at a university, receiving job training, or participating in treatment or counseling. The hour requirement could also be met through volunteer work.


Myth: People on Medicaid have no incentive to get a job. Enrollment discourages participants from working.


Fact: Montana’s voluntary job services program for Medicaid expansion enrollees, HELP-Link, is directly responsible for helping 78 percent of unemployed participants secure a job or find a better-paying job. The Montana Healthcare Foundation commissioned a report last year that tracked the more than 22,000 enrollees who signed up for employment assistance through the state’s unique job assistance program, and discovered that about 72 percent of program participants increased their average wages by $1,680 annually.


An earlier report from the Montana Healthcare Foundation showed that overall labor force participation among Medicaid expansion enrollees increased by 8.5 percent, even as the national participation rate dropped by 2.5 percent.


Myth: Medicaid expansion is bad for small businesses.


Fact: Medicaid expansion lifts the burden of providing expensive health insurance from small-business owners. The Montana Department of Labor and Industry’s report from this month shows that more than half of private businesses in the state — some 18,000 businesses — employ at least one worker who is enrolled in Medicaid expansion.


Larger businesses (those with more than 50 employees) benefit even more: 98 percent of these businesses employ at least one worker receiving Medicaid. But the benefit to small businesses is clear. The report notes that privately insuring all the workers covered by Medicaid expansion would have cost at least $354 million.


The numbers hold across the state, with at least 30 percent of businesses in every county counting at least one Medicaid expansion participant. And these businesses saved significant amounts of money. Private employer-based insurance coverage in Montana averages about $5,600 — per employee. On the other hand, employers who have employees enrolled in Medicaid expansion pay an average $630 per employee in income taxes.


Myth: Medicaid expansion creates a drag on the economy.


Fact: Medicaid expansion supports thousands of jobs and hundreds of millions in personal income in Montana. A report by the Bureau of Business and Economic Research at the University of Montana linked Medicaid expansion to 5,000 jobs and nearly $300 million in personal income. The latest analysis from the Montana Healthcare Foundation put the numbers even higher, projecting that by 2020, Medicaid expansion will contribute to 6,000 new jobs and $350,000 in personal income. The state economy benefits from Medicaid expansion to the tune of more than $600 million a year.


The cost to the state, meanwhile, is about $57.4 million a year, about $28.4 million of which is offset through savings generated by moving Medicaid enrollees from the regular plan to the expansion program, because the federal government pays a higher rate for expansion participants.


Buttrey’s bill proposes to further reduce the state’s share of the cost by expanding a tax on health insurance companies, taxing certain religious groups that had previously been exempt, and raising premiums paid by Medicaid enrollees. Yes, enrollees do pay a premium — about 2 percent of their total incomes, an average of about $26 per month.




Regardless of which bill ultimately finds its way to Gov. Steve Bullock’s desk for signing, the most important thing is that Montana continues this vital program that allows nearly 95,000 of our fellow Montanans to receive basic health care.


However, legislators must also make sure that the program continues to cover those who need it most, without putting up onerous barriers that only add to the state bureaucracy and keep people with legitimate needs from participating.


Full article here.

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