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‘Medicaid unwinding’ begins in Montana, sowing uncertainty for many (IR print copy)

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‘Medicaid unwinding’ begins in Montana, sowing uncertainty for many (IR print copy)


BILLINGS — When folks ask Ian Ward what he’s doing, he likes to say issues like “playin’ hack” – brief for hacky sack. However anybody who sees him is aware of he is paraplegic — paralyzed from the waist down.

A questioner unaccustomed to his banter typically lets out a half-choked chortle. Ward lets them dangle within the awkwardness for a second earlier than he laughs, inviting them in to share his macabre humor.

He’s been paralyzed for about 14 years, the results of a automotive accident when he was 26.

Taking a nook too quick, his automotive rolled and pitched down a hill. Inside was a unfastened 12-inch subwoofer speaker that tumbled with the movement of the automotive. In some unspecified time in the future Ward was ejected from the passenger window.

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A life-flight took him to St. Vincent’s Healthcare despite the fact that he was solely seven miles from the hospital. He sustained a traumatic mind damage and misplaced the usage of his legs. His digestive system and half of his diaphragm are paralyzed too.

Persons are additionally studying…

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The automotive he drives now has hand controls for the brake and the gasoline. However the automotive, a Ford Escape, wouldn’t be full with out the 12-inch subwoofer taking over the again.

“I can’t dwell with out it in my automotive,” Ward mentioned. “I simply can not dwell with out it.”

He could make mild of his situation, however the each day wrestle of managing his funds, his well being, and monitoring the standing of quite a few social companies is limitless and demanding.

Earlier this week he obtained a letter relating to his Medicaid enrollment. It sat in a pile of mail for awhile earlier than he opened it.

“I get stacks of mail from the OPA (Workplace of Public Help) every single day, so I don’t open them on a regular basis,” Ward mentioned. He’s on incapacity so the mail is often about spending down any extra cash so he can stay eligible for advantages.

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Ian Ward, 39, depends on Medicaid and Social Safety Revenue to fund the big variety of medicines required to deal with ache related along with his paraplegia, after dropping mobility in a extreme automotive crash greater than a decade in the past.

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The newest letter is concerning the “Medicaid Unwinding,” the huge reprocessing of each single Medicaid recipient in the USA.

It comes on the finish of the three 12 months COVID-19 public well being emergency (PHE) that’s anticipated to conclude on Could 11, 2023.

All through the pandemic, the PHE stored states from un-enrolling folks from the general public insurance coverage, and if states complied there could be enhanced federal funding to cowl extra prices.

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Due to the PHE, there are extra Medicaid enrollees than ever earlier than. As of April 7, greater than 322,000 Montanans have been coated by Medicaid.

The unwinding is a federal requirement, nevertheless it’s as much as particular person states to create and execute a plan.

States have 12 to 14 months to return to regular eligibility and enrollment operations, however some states are opting to wrap up quicker than that — Montana is one in every of them.

Solely six states have introduced that processing will probably be completed in lower than 12 months. Montana state well being division officers settled on a ten to 12 month unwinding.

Jackie Semmens with the Montana Funds and Coverage Heart mentioned choosing the quicker redetermination is essentially the most regarding piece concerning the state’s plan.

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“There’s a false impression with legislators,” mentioned Semmens. “The Medicaid (will increase) usually are not an emergency.”

A nasty monitor report

A part of the rationale this timeframe is so regarding is as a result of Montana has one of many worst monitor data within the nation in the case of Medicaid dedication — the a part of Medicaid enrollment that’s the accountability of the state well being division.

When an software for Medicaid enrollment arrives, it’s as much as the division to confirm the candidate’s data inside 45 days. Most states are in a position to course of the knowledge in every week or much less, some are even ready to take action inside 24 hours.

Montana, nonetheless, isn’t so environment friendly. Final September, 24% of Montana Medicaid functions weren’t processed throughout the 45-day timeframe, in accordance with knowledge from the Heart for Medicaid Providers. In July and August, 28% of candidates weren’t processed in time.

Solely Texas and Missouri outpaced Montana in overly lengthy processing occasions.

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And now state officers are taking up an unprecedented load of redeterminations to happen in 10 months. To not point out, it’s been three years because the final redetermination was made.

“Montana has extra severe issues than most different states,” mentioned Leighton Ku, director of the Heart for Well being Coverage Analysis at George Washington College. “(The well being division) doesn’t have workers or administration to do that huge job.”

Ku carried out analysis into Montana’s unwinding plan, talked with public well being suppliers and appeared on the state’s demographics and new laws. He predicted that below the state’s present plan, an estimated 71,000 folks will lose Medicaid.

To scale back the variety of errors that can inevitably dis-enroll eligible Montanans, Ku steered the state ought to take the total 14 months for the unwinding.

However the state well being division has not indicated the timeline will probably be up to date.

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“Processing redeterminations expediently and precisely is in one of the best curiosity of Medicaid members and Montana residents,” mentioned Jon Ebelt, communications director for the state well being division.

He added that the division has made vital investments in bettering the recruitment and retention of their workers.

“As to how nicely this works,” Ku mentioned, “that’s the state’s accountability and is dependent upon how folks reply.”

Disruptions in care

Clad in all black with gold accents, Ward’s apparel provides him away as a hip-hop fan. The model extends right down to his fingers the place his gold-banded rings are set with black stones.

Even his Air Jordan footwear have been a glossy black with tawny gold trim that matched the socks — black and gold, printed with pot leaves.

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Due to the exertion of getting dressed, Ward spoke from his medical mattress as an alternative of getting as much as his wheelchair.







Ian Ward

Ian Ward takes satisfaction within the variety of designer footwear that fill his closet in his bed room.

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Regardless of his accidents, he provides an air of invincibility.

“I learn (the Medicaid renewal), nevertheless it’s simply complicated,” Ward mentioned. “I’m not going to do something however be certain that my account’s below $2,000.”

Managing the adjustments within the social companies he depends on is especially tough for Ward. His traumatic mind damage results his short-term reminiscence, and it’s tough for him to be taught new issues.

It’s folks with some of these circumstances which have suppliers anxious. Numerous Montanans might fall off Medicaid on account of a processing error or an unreturned renewal packet, in accordance with Olivia Riutta, director of inhabitants well being for Cowl Montana

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And, like Ward, many individuals do not know the unwinding is occurring.

Weak Montanans

In Montana, any Medicaid recipient whose revenue, tax filings, addresses or any private contact data has modified within the final three years will obtain a Medicaid renewal bundle.

Since there hasn’t been a single redetermination completed since 2020, it’s possible that almost everybody on Medicaid will see a letter within the mail.

When it does arrive, Medicaid recipients can have 30 days to return it with all of the supporting documentation. If it’s not obtained within the 30 days, their Medicaid protection will finish.

Although the state plans to e mail and textual content reminders to those that have but to return their packet, there’s excessive chance that a few of Montana’s most weak will fall via the cracks.

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Native People will probably be disproportionately impacted by the transition, mentioned Tressie White with Montana Healthcare Basis.

Reservations are sometimes very rural with restricted mail service. Some journey to a P.O. Field, typically inconsistently because of the distance.

Folks have a tendency to maneuver typically on reservations too and problems with forwarding addresses already presents an issue, White mentioned.

No steady telephone numbers, inconsistent web connection and restricted entry to know-how are different main issues amongst tribal well being administrators, White mentioned.

For individuals who discover themselves not eligible for Medicaid, different backed choices can be found on Healthcare Market. However officers nonetheless count on the variety of uninsured residents to extend, resulting in gaps in care.

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A spot in care

When individuals are on Medicaid, they’re extra prone to partake in preventative drugs, retaining them more healthy and decreasing their well being care prices for yearly they’ve protection, in accordance with an annual report by the Montana Healthcare Basis.

For Ward, having a spot in protection could be unthinkable.

He’s on a minimum of eight completely different prescriptions, most of that are for ache administration. The neuropathy, or nerve ache, in his legs is insufferable more often than not and a gentle stream of medication are wanted to maintain it below management.







Ian Ward

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Ian Ward, 39, reads a letter from the State of Montana relating to eligibility necessities for staying enrolled in Montana Medicaid. Ward depends on Medicaid and Social Safety Revenue to fund the big variety of medicines required to deal with ache related along with his paraplegia, after dropping mobility in a extreme automotive crash greater than a decade in the past.




A house well being nurse stops by his home three days every week to supply important companies and his private care attendant is with him most days.

Not solely are these companies coated by Medicaid, nevertheless it’s tough to search out reliable folks to serve in these roles.

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Ward’s nephew acts as his private care attendant now, however earlier than a reliable member of the family took the job, a earlier assistant stole prescription medicines from him.

His situation makes him a magnet for drug seekers, main him to lock his prescriptions in a protected subsequent to his mattress.

A spot in protection might simply put Ward in an emergency scenario.

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‘Yellowstone’ highlights influence behind a changing Montana

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‘Yellowstone’ highlights influence behind a changing Montana



The popular “Yellowstone” TV series, set and filmed in Montana, taps into a lesser-known chapter of the state’s history: its settlement by Confederates and ex-Confederates during and after the Civil War.

I come to this story with a unique perspective. I’m a fourth-generation Montanan. I’m also a scholar of U.S. Western literary and cultural studies and left the state in my 20s to pursue a career in academia.

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Then, during the pandemic, I returned to Montana for a time to lead a statewide cultural organization that connects Montana’s history and literature to its modern-day residents.

That’s why, for me, the story of the show’s protagonist, John Dutton III, who heads a wealthy-but-embattled Montana ranching family, is not just a cultural phenomenon. Rather, “Yellowstone” offers insights into the dynamics that are currently influencing a changing Montana.

Montana’s little-known legacy

One of the series’ prequels, “1883,” provides the crucial backstory for the Dutton family’s journey to Montana.

James Dutton, portrayed by Tim McGraw, was a former Confederate captain; his wife, Maggie, was a nurse for the Confederate Army. In leaving behind their war-torn lives to seek new opportunities, they mirror the historical trend that saw Confederate settlers moving West during and after the Civil War.

According to Montana historian and scholar Ken Robison, Confederate prisoners of war languishing in Union prisons were paroled to western territories like Montana. By 1864, two such parolees had discovered gold in what is still called Confederate Gulch, at the time one of the largest settlements in Montana Territory. Other settlements, such as Dixie Town and Jeff Davis Gulch, dotted the landscape. Montana’s territorial capital was briefly called Varina, named after the Confederate president’s wife.

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Although there is no way to know for certain, it’s possible that during the latter half of the war, half of Montana Territory’s residents — maybe 30,000 — were pro-secession. Some had been in Confederate service; the rest shared their sentiments.

After the war, many of those Confederates stayed. By the late 1800s, Montana was home to 13 United Confederate Veterans organizations totaling 176 members. In 1916, the Montana Chapter of the Daughters of the Confederacy erected a Confederate memorial in Helena, the state capital; it stood for a century. The 1920s saw the rise of about 40 Ku Klux Klan chapters across the state to promote xenophobic policies against immigrants and racist policies against nonwhites. Today, Montana remains one of the whitest states in the U.S. — about 85% of Montanans are white; less than 1% are Black.

Recasting the ‘Lost Cause’

Numerous historical echoes surface briefly in “Yellowstone.”

In Season 2, there’s a violent confrontation involving a militia group that displays Confederate and “Don’t Tread on Me” flags. This subplot speaks to Montana’s long history as a hub for populist and anti-government movements. The Southern Poverty Law Center reports that Montana has 17 hate and anti-government groups, which include three defined as white supremacist or neo-Nazi.

This depiction of militia groups in “Yellowstone” represents the broader history of populist resistance in the American West. From the Sagebrush Rebellion of the 1970s to the Montana Freemen’s standoff with federal agents in the 1990s, Westerners have often resisted federal control over land and resources — tensions that perhaps trace back to the Confederacy’s own secession, a resistance rooted in defiance of federal authority, particularly over slavery.

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After the Confederacy’s defeat, the “Lost Cause” narrative, in an attempt to preserve Southern pride, recast the South’s secession as a fight for states’ rights, and not a defense of slavery.

Those Lost Cause connections reverberate through John Dutton III’s relentless battle to preserve his family’s ranch. Fighting overwhelming political and economic pressures, Dutton remains steadfast in his determination to hold onto the land, even when it goes against his best interests.

This tenacity reflects the Lost Cause mindset — a clinging to a nostalgia-tinged, yet unattainable, past. Dutton embodies the archetype of the “aggrieved white man,” a figure central to many populist movements, who feels displaced from his former position of power in politics, work and family life.

Populist contradictions

It’s hard to discern to what degree recent changes in Montana can be attributed to “Yellowstone.” What is certain: Today’s longtime Montana residents find themselves exposed to a fresh set of political, economic and cultural forces.

Tourism and the local economy are up, due in part to the “Yellowstone” effect. But so are concerns about the rising costs of most everything, particularly houses.

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These trends have been spurred, in part, by outsiders moving to Montana — newcomers who romanticize the state’s hardscrabble past and what they perceive as its current rough-hewn lifestyle.

What’s more, Montana has morphed from a purple state known for its political independence into a reliably conservative stronghold.

The drastic shift from purple to red solidified in 2020 with the election of a Republican governor after 16 years of Democratic leadership. It was further underscored by the defeat of Democratic Sen. Jon Tester by Republican Tim Sheehy in the 2024 election.

In “Yellowstone,” as Dutton is sworn in as Montana’s new Republican governor, he tells his constituents that he is “the opposite of progress” in response to changes that outside influences are bringing to the state.

Yet the politics of “Yellowstone” are “hard to pin down,” and the Duttons themselves espouse various versions of left- and right-wing populism as they simultaneously battle and embody the political and economic elite.

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By the same token, Montanans resent wealthy outsiders but have given them political power by voting them into office.

Montana’s current governor, Greg Gianforte, is a tech millionaire, originally from Pennsylvania; Sheehy, similarly, is a wealthy out-of-stater.

Neither one might approve of the fictional Gov. Dutton’s proposed policy of doubling property and sales taxes for out-of-state “transplants” — though many Montanans probably would. For some, the rapid changes of the past few years have been, like life for the Dutton family, a challenge.

Randi Lynn Tanglen served as professor of English at Austin College in Texas (2008-2020), executive director of Humanities Montana (2020-2022), and is currently vice provost for faculty affairs at the University of North Dakota (2023-present). She holds degrees from Rocky Mountain College,  the University of Montana and the University of Arizona.



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No. 2 Montana State whips No. 9 Montana 34-11, clinches 12-0 regular season

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No. 2 Montana State whips No. 9 Montana 34-11, clinches 12-0 regular season


BOZEMAN — The only thing that could have made this football season any sweeter for Montana State was the one thing that remained on its list of regular-season expectations.

Against their arch nemesis on Saturday, the Bobcats didn’t blink.

Adam Jones rushed for 197 yards and two touchdowns, the defense rose up and No. 2-ranked MSU took care of ninth-ranked Montana 34-11 to win the 123rd Brawl of the Wild at Bobcat Stadium.

Slim Kimmel / MTN Sports

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Montana State running back Adam Jones looks to evade Montana’s Ryder Meyer during the 123rd Brawl of the Wild at Bobcat Stadium in Bozeman on Saturday, Nov. 23, 2024.

With the win, the Bobcats clinched a perfect regular season at 12-0, won the outright Big Sky Conference title with an 8-0 league mark and in all likelihood secured a top-two seed and home-field advantage for the upcoming FCS playoffs — if not the overall No. 1 seed.

Though their running back corps was diminished with both Scottre Humphrey and Julius Davis in street clothes on the sideline, the Bobcats still rushed for 326 yards with Jones, a redshirt freshman out of Missoula Sentinel, leading the way.

The home team has now won five in a row in the storied history of the Cat-Griz rivalry, and Montana State has still not lost a regular-season home game in the four-year tenure of coach Brent Vigen.

Montana vs. Montana State

Slim Kimmel / MTN Sports

Montana and Montana State play in the 123rd Brawl of the Wild at Bobcat Stadium in Bozeman on Nov. 23, 2024.

The Bobcats established their running game at the outset by marching 75 yards on 14 plays, 12 of which were runs. Mellott capped the drive with a 5-yard touchdown run on what appeared to be a broken play to put MSU ahead 7-0.

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MSU converted two third downs on that drive and took nearly nine minutes off the clock.

A promising Griz drive was slowed by penalties in the second quarter, but Ty Morrison got Montana on the board by splitting the uprights on a 47-yard field goal to make the score 7-3.

But the Bobcats stretched their lead on the next possession when Mellott dropped a pretty pass over the top to tight end Rohan Jones for a 35-yard touchdown at the 10:16 mark of the second quarter.

Toward the end of the first half, the Bobcats got a 27-yard field goal from Myles Sansted to extend the lead to 17-3. With an even bigger kick, Sansted drilled a 49-yarder as time expired at halftime to extend it to 20-3.

Each team’s defense rose up in the second half as the offenses combined for five consecutive fruitless possessions. But with the Bobcats backed up on their own 5-yard line, Adam Jones exploded took a handoff and exploded through the line for an 88-yard gain.

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Montana vs. Montana State

Slim Kimmel / MTN Sports

Montana and Montana State play in the 123rd Brawl of the Wild at Bobcat Stadium in Bozeman on Saturday, Nov. 23, 2024.

Two plays later Jones punched it into the end zone from the 3 to put the Bobcats ahead 27-3 toward the end of the third quarter.

As the weather started to take a turn with strong wind and snow flurries, Montana scored its first touchdown early in the fourth on a 1-yard rush by Eli Gillman. Sawyer Racanelli then made a one-handed catch while being interfered with for a two-point conversion.

Jones, though, capped a 9-play, 71-yard drive with a 2-yard TD run with 4:49 remaining to ice the game.

The Grizzlies own the all-time series with a 74-43-5 record, but the Bobcats now have the edge with an 11-10 mark since 2002.

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Turning point: The game had hit a defensive standstill in the third quarter until Jones’ 88-yard burst to the UM 7. Griz safety Jaxon Lee prevented a touchdown, but two plays later Jones was in the end zone and the Bobcats had a 27-3 lead with 1:55 remaining in the third.

Stat of the game: The Bobcats rushed for more than 300 yards again, but perhaps more important was the defense’s ability to get off the field on third down.

Montana vs. Montana State

Slim Kimmel / MTN Sports

Montana and Montana State play in the 123rd Brawl of the Wild at Bobcat Stadium in Bozeman on Saturday, Nov. 23, 2024.

MSU’s defense held the Grizzlies to a 2 for 12 success rate on third down and forced seven punts. In the end, the Bobcats limited Montana’s offense to 234 total yards.

Game balls: MSU RB Adam Jones (Offense). Davis was injured in the first quarter and didn’t return and Humphrey had just one attempt, so Jones was called up on to take the brunt of the carries. He delivered with a standout performance.

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MSU S Rylan Ortt (Defense). The Bobcats defense played a great game overall, and Ortt was one of the ringleaders with 11 tackles (eight solo), was in on a tackle for loss and had one quarterback hurry.

MSU PK Myles Sansted (Special teams). Sansted hit both of his field goal tries, and his 49-yarder as time expired in the first half allowed MSU to take a 17-point lead into the locker room.

What’s next: With a 12-0 record, Montana State is in line for a top-two seed in the FCS playoffs, which would mean a first-round bye and home-field advantage through the semifinal round. The Cats could get the No. 1 overall seed after South Dakota beat North Dakota State 29-28.

The Grizzlies, who are now 8-4 (and 5-3 in the Big Sky), are likely to receive an at-large bid into the tournament.

The 24-team bracket will be announced Sunday with the 2024 NCAA Division I Championship Selection Show on Sunday at 10:30 p.m. Mountain time on ESPNU. The show is also available for streaming on ESPN+.

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In Montana, conservative groups see a chance to kill Medicaid expansion • Daily Montanan

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In Montana, conservative groups see a chance to kill Medicaid expansion • Daily Montanan


Conservative groups are working to undermine support for Montana’s Medicaid expansion in hopes the state will abandon the program. The rollback would be the first in the decade since the Affordable Care Act began allowing states to cover more people with low incomes.

Montana’s expansion, which insures roughly 78,800 people, is set to expire next year unless the legislature and governor opt to renew it. Opponents see a rare opportunity to eliminate Medicaid expansion in one of the 40 states that have approved it.

The Foundation for Government Accountability and Paragon Health Institute, think tanks funded by conservative groups, told Montana lawmakers in September that the program’s enrollment and costs are bloated and that the overloaded system harms access to care for the most vulnerable.

Manatt, a consulting firm that has studied Montana’s Medicaid program for years, then presented legislators with the opposite take, stating that more people have access to critical treatment because of Medicaid expansion. Those who support the program say the conservative groups’ arguments are flawed.

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State Rep. Bob Keenan, a Republican who chairs the Health and Human Services Interim Budget Committee, which heard the dueling arguments, said the decision to kill or continue Medicaid expansion “comes down to who believes what.”

The expansion program extends Medicaid coverage to adults with incomes up to 138% of the federal poverty level, or nearly $21,000 a year for a single person. Before, the program was largely reserved for children, people with disabilities, and pregnant women. The federal government covers 90% of the expansion cost while states pick up the rest.

National Medicaid researchers have said Montana is the only state considering shelving its expansion in 2025. Others could follow.

New Hampshire legislators in 2023 extended the state’s expansion for seven years and this year blocked legislation to make it permanent. Utah has provisions to scale back or end its Medicaid expansion program if federal contributions drop.

FGA and Paragon have long argued against Medicaid expansion. Tax records show their funders include some large organizations pushing conservative agendas. That includes the 85 Fund, which is backed by Leonard Leo, a conservative activist best known for his efforts to fill the courts with conservative judges.

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The president of Paragon Health Institute is Brian Blase, who served as a special assistant to former President Donald Trump and is a visiting fellow at FGA, which quotes him as praising the organization for its “conservative policy wins” across states. He was also announced in 2019 as a visiting fellow at the Heritage Foundation, which was behind the Project 2025 presidential blueprint, which proposes restricting Medicaid eligibility and benefits.

Paragon spokesperson Anthony Wojtkowiak said its work isn’t directed by any political party or donor. He said Paragon is a nonpartisan nonprofit and responds to policymakers interested in learning more about its analyses.

“In the instance of Montana, Paragon does not have a role in the debate around Medicaid expansion, other than the testimony,” he said.

FGA declined an interview request. As early as last year, the organization began calling on Montana lawmakers to reject reauthorizing the program. It also released a video this year of Montana Republican Rep. Jane Gillette saying the state should allow its expansion to expire.

Gillette requested the FGA and Paragon presentations to state lawmakers, according to Keenan. He said Democratic lawmakers responded by requesting the Manatt presentation.

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Manatt’s research was contracted by the Montana Healthcare Foundation, whose mission is to improve the health of Montanans. Its latest report also received support from the state’s hospital association.

The Montana Healthcare Foundation is a funder of KFF Health News, an independent national newsroom that is part of the health information nonprofit KFF.

Bryce Ward, a Montana health economist who studies Medicaid expansion, said some of the antiexpansion arguments don’t add up.

For example, Hayden Dublois, FGA’s data and analytics director, told Montana lawmakers that in 2022 72% of able-bodied adults on Montana’s Medicaid program weren’t working. If that data refers to adults without disabilities, that would come to 97,000 jobless Medicaid enrollees, Ward said. He said that’s just shy of the state’s total population who reported no income at the time, most of whom didn’t qualify for Medicaid.

“It’s simply not plausible,” Ward said.

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A Manatt report, citing federal survey data, showed 66% of Montana adults on Medicaid have jobs and an additional 11% attend school.

FGA didn’t respond to a request for its data, which Dublois said in the committee hearing came through a state records request.

Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, also declined to comment. As of late October, a KFF Health News records request for the data the state provided FGA was pending.

In his presentation before Montana lawmakers, Blase said the most vulnerable people on Medicaid are worse off due to expansion as resources pool toward new enrollees.

“Some people got more medical care; some people got less medical care,” Blase said.

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Reports released by the state show its standard monthly reimbursement per Medicaid enrollee remained relatively flat for seniors and adults who are blind or have disabilities.

Drew Gonshorowski, a researcher with Paragon, cited data from a federal Medicaid commission that shows that, overall, states spend more on adults who qualified through the expansion programs than they do on others on Medicaid. That data also shows states spend more on seniors and people with disabilities than on the broader adult population insured by Medicaid, which is also true in Montana.

Nationally, states with expansions spend more money on people enrolled in Medicaid across eligibility groups compared with nonexpansion states, according to a KFF report.

Zoe Barnard, a senior adviser for Manatt who worked for Montana’s health department for nearly 10 years, said not only has the state’s uninsured rate dropped by 30% since it expanded Medicaid, but also some specialty services have grown as more people access care.

FGA has long lobbied nonexpansion states, including Texas, Kansas, and Mississippi, to leave Medicaid expansion alone. In February, an FGA representative testified in support of an Idaho bill that included an expansion repeal trigger if the state couldn’t meet a set of rules, including instituting work requirements and capping enrollment. The bill failed.

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Paragon produced an analysis titled “Resisting the Wave of Medicaid Expansion,” and Blase testified to Texas lawmakers this year on the value of continuing to keep expansion out of the Lone Star State.

On the federal level, Paragon recently proposed a Medicaid overhaul plan to phase out the federal 90% matching rate for expansion enrollees, among other changes to cut spending. The left-leaning Center on Budget and Policy Priorities has countered that such ideas would leave more people without care.

In Montana, Republicans are defending a supermajority they didn’t have when a bipartisan group passed the expansion in 2015 and renewed it in 2019. Also unlike before, there’s now a Republican in the governor’s office. Gov. Greg Gianforte is up for reelection and has said the safety net is important but shouldn’t get too big.

Keenan, the Republican lawmaker, predicted the expansion debate won’t be clear-cut when legislators convene in January.

“Medicaid expansion is not a yes or no. It’s going to be a negotiated decision,” he said.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.



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