Montana
Medicaid Expansion Debate Will Affect Other Health Policy Issues Before Montana Legislature – Flathead Beacon
HELENA – A last-minute change to a 2019 bill put an end date on Montana’s Medicaid expansion program, setting the stage for what is anticipated to be the most significant health care debate of the 2025 Montana Legislature.
In recent interviews, legislative leaders predicted a vigorous debate over keeping the Medicaid expansion program, which pays the medical bills of more than 75,000 low-income Montanans at an annual cost of about $1 billion to the federal and state governments. They also expect the topic to seep into other health policy decisions, such as the approval of new spending on Montana’s behavioral health system and regulation of hospital tax-exempt status.
“It all kind of links together,” said state Sen. Dennis Lenz, a Billings Republican and chair of the Senate Public Health, Welfare, and Safety Committee.
Legislators from both parties also expect lawmakers from the GOP majority to continue to pursue abortion restrictions, despite a November statewide vote making abortion a right under the Montana Constitution.
The Medicaid expansion debate, however, looms largest among the health care topics.
“This is definitely the elephant in the room, so to speak,” said Senate Minority Leader Pat Flowers, a Belgrade Democrat.
Montana expanded Medicaid, initially for four years, in 2015, through a coalition of minority Democrats, some moderate Republicans, and a Democratic governor. A similar coalition renewed the program in 2019, but at the last moment, Senate Republicans tacked on an end date of June 30, 2025. That put the matter in the lap of this year’s legislature.
Republicans still hold strong majorities in the state House and Senate, whose leaders voiced concerns about the expansion program.
This time around, the governor — Greg Gianforte — is a Republican. Last year, the Gianforte administration completed a postpandemic eligibility reassessment that cut the number of expansion enrollees from a high of 125,000 people in April and May 2023 to approximately 76,600 people as of October, the most recent data available.
Gianforte has included funding for Medicaid expansion in his proposed budget, which must be approved by the legislature to take effect. His office said he wants “strong work requirements for able-bodied adults without dependents” to take part in the program. Spokesperson Kaitlin Price said the governor “has been clear that the safety net of Medicaid should be there for those who truly need it, but that it will collapse if all are allowed to climb on it.”
GOP legislative leaders clearly are skeptical of the program, saying it won’t continue without some “sideboards,” or additional requirements of enrollees and providers.
Whether any expansion bill passes “will depend on the people pushing it,” said Senate President Matt Regier, a Kalispell Republican who opposes expansion. “If there is no give-and-take, it could be an interesting vote.”
Flowers said he knows getting Medicaid expansion through the Senate will be tough. Republicans hold a 32-18 majority, and the GOP caucus leans conservative.
“There are a lot of my colleagues on the Republican side that are ideologically opposed, and I think you’re going to see that in their consistent voting against reauthorizing,” Flowers said.
Medicaid, funded by both the state and federal governments, provides health coverage for certain groups of low-income people. Expansion extended Medicaid coverage to nondisabled adults ages 19 to 64 with incomes up to 138% of the federal poverty level — about $20,800 a year for an individual in 2024.
The 2010 federal Affordable Care Act opened Medicaid to this new group of adults, starting in 2014. But a 2012 U.S. Supreme Court ruling said states could choose whether to adopt the change, and 40 have done so.
Republican state Rep. Ed Buttrey said he would sponsor a bill to reauthorize Medicaid expansion without an expiration date, but many GOP lawmakers remain unconvinced that expansion is needed, viewing it as a costly, unnecessary welfare program.
“I understand there are some pros to Medicaid expansion, but, as a conservative, I do have issues with — I guess I can’t get around it — socialized medicine,” said House Speaker Brandon Ler (R-Savage).
In September, representatives from a pair of conservative-funded think tanks made a case for ending Medicaid expansion, saying its enrollment and costs are bloated. The consulting firm Manatt, on the other hand, said more people have access to critical treatment because of Medicaid expansion.
At the least, it appears many Republicans want to require participants to work, pay premiums, or meet other conditions, if the program is to continue.
Premiums and work requirements are in Montana’s law right now. The Biden administration, though, nixed both, so they haven’t been in effect. Montana Republicans expect the incoming Trump administration to be more open to such provisions.
Democrats say Medicaid expansion has succeeded on many fronts: covering thousands of low-income workers, helping keep rural health care providers and hospitals afloat, and bringing hundreds of millions of federal dollars into Montana’s economy. The state pays 10% of the program’s costs, which totaled about $962.4 million in fiscal year 2024. The federal government picked up $870 million of that tab.
“With all that, it’s just stunning to me that there could be opposition,” Flowers said. “There is just no reason for us, collectively as a state, not to support this.”
Democrats will have their own expansion bill, brought by Rep. Mary Caferro of Helena. She said the bill would remove the work requirements and premiums, shine more light on the contracting activities of the state health department, and reopen some public assistance offices that have been closed. It also would make expansion permanent.
“We’re 10 years into this program,” said Rep. SJ Howell of Missoula, the Democratic vice chair of the House Human Services Committee, which debates health policy legislation. “I think that continuing a cycle of uncertainty for patients and providers doesn’t make sense.”
Legislators also see the expansion debate tying into other health care discussions.
Regier and Lenz said Montana’s nonprofit hospitals — strong supporters of expansion — have benefited greatly from the program and may need to give something back in return. One possibility: more government oversight of the “community benefits” that hospitals must provide to receive tax-exempt status.
They also noted that Montanans pay a fee for hospital stays to support the Medicaid program and that a fee on hospital outpatient revenue helps pay the costs of Medicaid expansion. Those fees and the resulting money raised for hospitals may merit review, they said.
Meanwhile, backers said Medicaid expansion underpins one of the governor’s major policy priorities, to improve the state’s behavioral health system. Gianforte has proposed spending up to $100 million over the next two years on 10 recommendations made by an advisory commission that reviewed the system for the past 18 months.
If Medicaid expansion ends, many adults would lose access to the mental health and addiction treatment system that Gianforte wants to improve, advocates said, while treatment providers would lose a significant source of revenue.
Money for the behavioral health changes would come, in part, from a $300 million fund created by the 2023 legislature. Lawmakers plan to scrutinize Gianforte’s proposals during the budgeting process. Howell said Democrats want to look at whether the changes would use enough of the $300 million fund quickly enough and on the most pressing needs.
Meanwhile, Republicans said they’ll likely introduce bills on abortion — even though Montanans approved Constitutional Initiative 128 by a 58-42 margin in November. CI-128 said the right to an abortion cannot be “denied or burdened” except by a “compelling government interest achieved by the least restrictive means.”
“It’s not going to slow us down in our pro-life positions,” Ler said of CI-128.
At a minimum, GOP leaders said, some of CI-128’s terms should be defined.
“With a very poorly written ballot initiative like that, we need to say, ‘What does that abortion industry look like under CI-128 and what’s our role as a state?’” Regier said.
But state Sen. Cora Neumann, a Bozeman Democrat on the Senate Public Health, Welfare, and Safety Committee, said the CI-128 vote provided a strong mandate for the right of privacy.
Enacting restrictions would lead to “that slippery slope of what’s next, if we allow legislators to rule on what’s happening in the doctor’s office,” she said. “What kind of can of worms could be opened to other invasions of privacy?”
Montana
Montana Public Service Commission watches bill that cuts public participation • Daily Montanan
The Montana Public Service Commission elected former and incoming commissioner Brad Molnar as its new president this week, and it discussed legislative priorities for the session, including a bill that would make “extensive” changes to the way utilities plan for energy resources.
Molnar, a former state Senator, previously served on the commission from 2004 through 2012. The Laurel Republican takes the leadership title from Jim Brown, former PSC president sworn in this week as State Auditor.
The Public Service Commission regulates monopoly utilities, and at its meeting Tuesday, the five commissioners discussed bills that were coming up in the 2025 Montana Legislature, ones they had proposed and ones that came out of legislative work between sessions.
At the meeting, PSC external affairs coordinator Trevor Graff gave a staff report on the bills, including House Bill 55, to change the way public utilities plan and acquire energy resource and speed up parts of the process.
In part, Graff said, the “extensive” bill proposes a “quick turnaround” time of 120 days for energy planning processes, “significantly shorter” than the current nine months set in commission rules.
NorthWestern Energy currently has such an effort underway. It’s a matter of high public interest, and it entails a process under scrutiny by the public and advocacy groups.
The bill also would cut the minimum time for public comment from 60 days to 45 days.
As drafted, the Public Service Commission would be allowed to skip public comment on plans by utilities for their future energy portfolio. However, it asks utilities to potentially hold more meetings, four instead of two, but with the possibility to forego two if the PSC approves.
The bill came out of a select committee on energy resource planning, and its goal appeared to be to shift the public participation component of the process from the PSC to the utilities, Graff said.
He said the idea from the legislative committee seemed to be to take off some of the burden of collecting public comment from the PSC, although he said it’s probably good for the PSC to hear from citizens for its own records.
“You still, under this bill, have the prerogative to do that (hold a hearing on a resource plan), and you aren’t required to do that at all if you so choose,” Graff said.
The draft raised other questions for the PSC as well, he said, including a call for a couple more regulatory analysts at the commission, but with half of the estimated funding for it, and with money that’s not in the agency’s permanent budget.
HB-55 will be up for a hearing Friday in House Energy, Technology and Federal Relations Committee.
In his staff report, Graff said bills in Senate Energy are getting pushed to next week given a slowdown in the Senate. A change in the rules shuffled the work and members in committees.
Graff also reminded commissioners that their policies state the PSC will generally present a unified front before the public, the media and the legislature. In other words, commissioners who are stepping out on their own should be clear that’s the case.
At the meeting, the commission’s first order of business was electing new officers, and Vice President Jennifer Fielder broke a tie to continue to serve as vice president; she said it was extra work, but she also represented continuity in the role.
In a leadership role, Fielder said it was important to pay attention to operations, and the agency in the past had been left in “disarray” because of neglect.
“A great deal of that was because agency leadership was engaged in policy advancement, and that was wonderful, but nobody was here paying attention to the agency itself,” Fielder said, noting the importance of ensuring quality staff.
The PSC is made up five Republicans, and Commissioners Annie Bukacek and Molnar supported Fielder for vice president. Commissioners Randy Pinocci and Jeff Welborn supported Pinocci for vice president.
Fielder, of Thompson Falls, Molnar, of Laurel, and Welborn, of Dillon and also previously a state legislator, took their oaths of office this week, Welborn for the first time.
Incoming Commissioner Welborn said he was excited to work on ensuring access to reliable and affordable utility services.
“Looking ahead to the next four years, I will prioritize strengthening our energy grid and producing more energy exports to lower rates for everyone,” Welborn said in a statement.
Molnar said he was humbled to have been selected with a unanimous vote, pleased Fielder would remain as vice president, and anticipated a smooth legislative session.
“With the governor’s budget restoring lost personnel, we expect to be able to better and more timely serve the families and employers that rely on us, as well as the utilities that serve us,” Molnar said in a statement from the PSC.
The PSC also is tracking House Bill 103, to change railroad track inspection.
It’s following a couple of telecommunications bills, House Bill 45, a “rehash” of a telecommunications revision bill from the 2023 session, and Senate Bill 51, to adjust telecoms registration requirements.
A change in Senate rules on the first day of the Montana Legislature led to “messed up” planning and stalled some bills.
A print-out of committee hearings for the second day of the session was mostly blank.
Tuesday was just the second day of the 69th session, however, and, according to at least a couple of senators, some politics are expected along the way, and slight delays aren’t all bad, at least this early in the game.
In a briefing earlier in the day, Senate President Matt Regier, R-Kalispell, said the bid for new rules that led to the slowdown had surprised him, and it had serious consequences.
“It was a reshuffling of the deck, which, to me, was very … dismissive of the caucus and everything we did in November and the two months prior,” Regier said.
The previous day, a band of Republicans teamed up with Democrats to change the rules in the Senate, and on Tuesday, some, but not all, committee chairs stood up on the floor and said they had yet to get off the ground.
“Senate Judiciary is still going on a field trip,” said Sen. Barry Usher, R-Billings.
“Stay tuned,” said Sen. Greg Hertz, R-Polson, about Senate Tax.
The sloshing in the Senate caught the attention of the House.
In House Appropriations, Chairperson Llew Jones, R-Conrad, shared ground rules about how the largest committee worked and how it fit into the work at the Capitol, with a side note about the status in the Senate.
“Senate is in a little bit of chaos about who’s on where,” Jones said.
During the first Senate floor session one day earlier, Minority Leader Pat Flowers, D-Belgrade, proposed doing away with an executive review committee in the way Republican leaders had set it up.
At the time, Flowers said its purpose was unclear, and Democrats from the minority caucus were needed on other committees.
Sen. Jason Ellsworth, a Hamilton Republican and former Senate president, also advocated for a structure that did more to spread out the expertise of lawmakers, and he and eight other Republicans voted with Democrats.
Regier said the change meant in just 15 minutes, a couple months’ worth of logistics unraveled, everything from committee assignments to letterhead and business cards.
On the floor, he said the legislative website still had incorrect hearing meeting times, and proper ones would be printed and posted in a public space outside chambers when available.
“We’re working our tails off to get that all in sync,” Regier said.
The delays weren’t all bad, though.
The Senate wrapped up quickly Tuesday, and afterwards, Sen. Janet Ellis, D-Helena, said it was early enough in the legislative session, she wouldn’t characterize the changes with committees as disruptive.
Ellis also said she was working on a bill that dipped into some unfamiliar territory — about artificial intelligence in elections — so she saw a silver lining.
“I’m glad I have some time to prepare,” Ellis said.
Not all committees were delayed as a result, and some were having “educational” meetings instead of taking up proposed bills.
Earlier in the day, Regier said the new rules were just temporary, and the Senate might revert to the plan from leadership when it adopted permanent rules. He said he would defend the work his caucus did, but he couldn’t predict an outcome, either.
“This is politics, right?” Regier said.
Coming out of the floor session, Sen. Jonathan Windy Boy, D-Box Elder, said the same thing about the brake tap on committees.
“That’s why we’re here. Politics,” Windy Boy said. “Sometimes, some people don’t get what they want. Some do. It’s like two kids playing in the playground. Some get to play with the toys, and some don’t.”
Montana State quarterback Tommy Mellott didn’t hesitate when reacting to losing the FCS national title.
The Bobcats entered the FCS national title game a perfect 15-0 against 13-2 North Dakota State, and were favored to leave Frisco as national champions.
Things didn’t go according to plan. NDSU was up 21-3 at halftime, and while Mellott pulled off some incredible second half heroics, the Bobcats still lost 35-32.
Montana State lost the FCS national title game 35-32 to the North Dakota State Bison. (Photo by Matthew Pearce/Icon Sportswire via Getty Images)
Tommy Mellott reacts to national title loss.
Mellott’s college career ended Monday night in Frisco on the field, and he felt the better team was going home with a loss. He also took a moment to acknowledge God in his postgame press conference.
“This year was very special. Hats off to North Dakota State for beating us today. Unfortunately, I think the better team lost, but that’s how it goes sometimes. It’s football. That’s why they play the game. You know, we just didn’t play the right game. God is good in all circumstances, and I trust that,” a visibly crushed Mellott said after the stunning loss.
You can watch his comments below starting around 4:50, and let me know your thoughts at David.Hookstead@outkick.com.
It’s truly too bad Mellott didn’t get to end his historic FCS career with a national title. Montana State had an insane run this season, but like the dual-threat QB said, the game is played for a reason.
A team can be the favorite and undefeated and still be upset. That’s the way sports work.
What’s arguably most impressive is the fact Mellott nearly brought the Bobcats back from an 18-point deficit.
He finished the game with three total touchdowns and 330 yards of offense. The team fell just three points short of forcing OT and giving fans a legendary ending.
North Dakota State upset Montana STate in the FCS national title game. (Photo by George Walker/Icon Sportswire via Getty Images)
Mellott’s incredible run in Bozeman is finally over, and it will be fascinating to see how he translates to the NFL. He’s a true freak of nature athlete. It’s hard to imagine he’s not going to get a serious look after being the best player in the FCS. Hopefully, he finds success at the next level. Let me know what you think at David.Hookstead@outkick.com.
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