AP NEWS

Republicans want Medicaid expansion without additional costs

January 30, 2019
FILE - In this Jan. 8, 2019 file photio, Rep. Ed Buttrey, R-Great Falls, talks during a House Rules Committee meeting in Helena. An early version of a bill Buttrey is working on to continue Medicaid expansion in Montana without increasing costs to taxpayers involves increasing some individuals' premiums, collecting fees from tax-exempt religious corporations and taxing hospitals that benefit from the infusion of federal money. (Thom Bridge/Independent Record via AP, File)

HELENA, Mont. (AP) — An early version of a Republican plan to continue the state’s Medicaid expansion program without taking on additional costs involves raising premiums, assessing some taxes and collecting money from tax-exempt religious corporations, according to a bill draft obtained by The Associated Press on Wednesday.

The bill is being drafted by Rep. Ed Buttrey, who sponsored the original 2015 legislation that has led to Medicaid coverage for about 95,000 additional adults in the state. The program will end in July if the Legislature does not reach a compromise, and Buttrey is seen as a bridge between Democratic Gov. Steve Bullock and the Republican-led Legislature.

“The whole plan ... was to generate from the parties that benefit from the program at least enough money to cover the increase to the state,” as the federal share of program spending declines, Buttrey said Wednesday.

A recent study found the expanded health care program for low-income adults brings $600 million into the state’s economy each year, creating more than 6,000 jobs and $350 million in personal income, while hospitals have seen their $400 million in uncompensated care drop by half.

Buttrey proposes taxes on hospital services and health insurance premiums and other assessments to help pay for the state’s share of the federal program. His bill would increase the 2 percent premiums for those who remain on Medicaid expansion for more than two years, capping premiums at 5 percent of a person’s annual income. Buttrey cautions the bill could change.

The bill creates an account to hold the taxes, fees and premium increases along with the $28 million the state estimates it saves annually by transferring some people who qualify for traditional Medicaid to Medicaid expansion, which has a higher federal reimbursement rate. The money in that account would be used to pay the state’s share of Medicaid expansion costs before general fund money would be tapped.

Republicans have also said they want to see some sort of means and asset testing for participants. However, the Medicaid program does not allow such regulations.

“You can’t throw someone off the program because they have too many assets,” Buttrey said. “But we can increase an assessment with the Department Revenue so they end up paying more to be on the program.”

Montana’s current Medicaid expansion law includes a “taxpayer integrity fee” that acts as an asset test by charging additional fees to people who may qualify for Medicaid expansion via their income but have assets beyond a house worth up to $250,000, a vehicle and $50,000 in cash. It charges a $100 monthly fee plus $4 per month for each $1,000 in assets above the limit. Buttrey proposes removing cash as an asset and adding the value of a person’s land.

His bill also seeks to assess tax-exempt religious corporations, such as Hutterite colonies, a percentage of the corporation’s income equal to the state’s matching rate for Medicaid expansion claims. States will be responsible for a 10 percent match starting in 2020.

The draft includes a measure that would end Montana’s Medicaid expansion program if the federal government fails to authorize a section that would require most recipients to work, volunteer, go to school or undergo behavioral or chemical dependency counseling for a minimum of 80 hours a month.

“Governor Bullock has concerns that several of the provisions are against federal law, will increase uncompensated care costs and are designed to increase the number of uninsured Montanans — undermining Montana’s success in making sure that enrollees can find or keep a job,” the administration said in a statement.

Democratic lawmakers have proposed maintaining the current Medicaid expansion program.