A proposal from Republicans to maintain the current levels of Medicaid coverage in Montana has been approved and is now waiting for the governor’s approval. This decision comes at a time when Congress is contemplating significant reductions in funding for the health program that supports low-income individuals.
On Thursday, the Montana Senate passed the bill with a 30-20 vote. Without intervention, expanded Medicaid coverage, which benefits over 76,000 residents of Montana, was on track to expire. Republican Governor Greg Gianforte, who has previously supported the continuation of this coverage, has not yet made a public statement specifically regarding this proposal.
A group comprising moderate Republicans and Democrats managed to push the bill through, overcoming opposition from conservative GOP leaders in the Senate. The new measure introduces work requirements for certain Medicaid beneficiaries in Montana—a provision that was blocked during President Joe Biden’s administration.
In 2015, Montana extended Medicaid coverage to adults aged 18 to 65 with modest incomes, beyond the federal poverty line. Prior to the Affordable Care Act, Medicaid was primarily available to disabled individuals, expectant mothers, seniors, and low-income children. The expansion has allowed around 80 million Americans to access Medicaid.
The state reaffirmed this expansion in 2019 but set a deadline for it to expire this summer. The newly passed bill removes the requirement for lawmakers to periodically renew the program, providing more stability moving forward.
State Rep. Ed Buttrey, a Republican from Great Falls and the bill’s author, emphasized that the program has served as a crucial support system for low-income Montanans and rural health care providers, who benefit financially from decreased uninsured patient costs. Medicaid’s expansion has been particularly significant for Montana’s Native American community, greatly improving access to healthcare and reducing pressure on the Indian Health Services.
While most states receive additional federal assistance for expanded Medicaid coverage, Montana’s share from the federal government stands at approximately 90% of the $1 billion annual cost. However, some opt against the program, including state Sen. Carl Glimm, who cautioned that future funding cuts by Congress could impose a heavy financial burden on Montana. The extensive Medicaid program is under scrutiny by the GOP, which aims to curb federal expenditures.
Montana is among nine states with laws that automatically end Medicaid expansion if federal support decreases. The law mandates that the state identify alternative funding sources if there is a drop in federal contributions. U.S. House Speaker Mike Johnson recently suggested implementing work requirements tied to Medicaid eligibility, a measure that Montana and other states have previously sought, but was blocked under Biden’s administration.
The health policy research firm, KFF, reports that about 92% of Medicaid beneficiaries are either employed, in school, or providing care. The pending bill at Governor Gianforte’s desk would bring back Montana’s initiative for work requirements, a change that might find favor with a more receptive federal administration.
Gianforte stated, “It’s a safety net we need to have, but we also have to make sure the people that get in the safety net doesn’t cause the safety net to collapse under its weight.” In line with these views, Republican governors in states like Arkansas, Iowa, and Ohio have announced intentions to seek federal approval to initiate work requirements. South Dakota’s electorate approved a similar measure last year, pending federal authorization. Notably, when Arkansas implemented work requirements during Donald Trump’s presidency, about 18,000 individuals lost coverage, though the mandate was later halted by a federal judge.
