Montana
Montana could be a model as more GOP states weigh Medicaid work requirements • Stateline
Two decades ago, Jeff Beisecker and his family returned to Great Falls, Montana, from a religious mission to the Philippines. Beisecker had no health insurance and no steady source of income, and neither did his wife. Fearful of being without coverage, Beisecker enrolled himself, his wife and their four children in Medicaid for nearly a decade while he worked his way to a steady, full-time job.
Having the extra help made a difference for his family, recalled Beisecker, 53. “And people might have looked down on us. I don’t really care, because it was there to help us along the journey.”
For Beisecker, Medicaid coverage was a launching pad to stable work; now he helps others make that leap. As an employment and training coordinator for Opportunities Inc., a Great Falls-based nonprofit, Beisecker connects Montana Medicaid recipients to job training, career counseling, transportation and child care. Opportunities Inc. is one of several nonprofits that run a state-created voluntary program called the Health and Economic Livelihood Partnership Link, known as HELP-Link.
“When folks come in, we can meet with them and say, ‘Hey, maybe you can take this training that we can help pay for, and you can come out and start making 28 or 29 dollars an hour,” Beisecker said.
An increasing number of Republican-led states want to require Medicaid recipients to work, arguing that doing so will help them rise out of poverty. Democrats and health advocates note that most people on Medicaid already work either full time or part time. They argue that states shouldn’t deny health care coverage to people who don’t have jobs, especially since many face serious barriers to employment.
With HELP-Link, Montana might have found middle ground.
Holdout states consider expanding Medicaid — with work requirements
When Montanans enroll in Medicaid, nonprofit organizations such as Opportunities Inc., which receives state funding, can offer career guidance and job training from professionals like Beisecker. A key part of that process is identifying barriers to work — such as a lack of training, child care or transportation — and finding ways to overcome them.
“There are ways to support work without taking away people’s health coverage,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families, which researches health care issues.
“Montana is the most concrete example of a work-support connection,” she said. “That’s one place to look to make sure people are connected to work supports and job training.”
Montana Republican state Rep. Edward Buttrey, who crafted the HELP-Link program with Democratic state Rep. Mary Caffero in 2015, said it adheres to GOP principles.
“Republican administrations typically want to ensure that if somebody’s getting a benefit from the taxpayers, that they’re earning it and in return providing a benefit back to the state and themselves,” Buttrey told Stateline. “I think that’s what this is about.”
Caffero said that in reaching a compromise, legislators “put the people of Montana above party politics.”
“We created our own majority,” she said, “and extremists were kind of out on a plank.”
Increasing interest
Medicaid is a program that provides health insurance for low-income people and is jointly run by states and the U.S. government. Any state that wants to add a work requirement to Medicaid must ask the federal government for permission.
Grassroots groups help Medicaid recipients regain lost coverage
The Biden administration has repeatedly turned down states’ requests to impose work requirements. It also has rescinded the approvals granted by its predecessor, which signed off on 13 of them. (Only one state, Arkansas, implemented its rule before courts blocked states from imposing them.) But with the election fast approaching, the prospect of a second Trump administration has prompted more GOP states to reconsider the idea.
That includes states such as Arkansas, Idaho and Louisiana that opted to expand Medicaid to more people under the Affordable Care Act, commonly known as Obamacare. It also includes states that are still debating whether to expand Medicaid under Obamacare, among them Kansas and Mississippi.
Georgia and South Carolina, neither of which has expanded Medicaid under the ACA, both have sought federal permission to include work requirements in partial expansions of Medicaid that are more limited than what is envisioned under Obamacare. Only Georgia, which is fighting the Biden administration in court, currently has a strict work rule for any of its Medicaid enrollees.
How it works
Montana, which expanded Medicaid during the Obama administration, in 2019 sought federal permission to apply work requirements to the roughly 100,000 adults who were newly eligible for the program. Under the proposal, beneficiaries would have had to work at least 80 hours each month, be looking for a job, or be doing volunteer work. There would have been exemptions for pregnancy, disabilities and mental illness.
In 2021, however, the Biden administration rejected Montana’s request. Buttrey told Stateline that if former President Donald Trump wins in November, it is likely that Montana will try again. But whatever the outcome of the election, the voluntary workforce training in HELP-Link has emerged as a possible compromise.
Beisecker said that Opportunities Inc. has been working with the Help-Link program for about a year and a half. The nonprofit has been able to help people do things such as get a commercial driver’s license, start a welding certificate program, take classes on medical coding, and join construction training programs.
When folks come in, we can meet with them and say, ‘Hey, maybe you can take this training that we can help pay for, and you can come out and start making 28 or 29 dollars an hour.
– Jeff Beisecker, employment and training coordinator for Opportunities Inc., a Montana nonprofit
The nonprofit also has a community resource center that can help Medicaid recipients get access to vouchers for food, laundry facilities and other needs.
“We get referrals from other nonprofits we work with,” Beisecker said. “We have flyers that we send out so people know about the program. We go to job fairs.”
According to data from the Montana Department of Labor and Industry, more than 2,200 people have participated in the HELP-Link program since its inception. Many have gone on to get jobs as registered nurses, dental hygienists, real estate agents and computer programmers, among many other professions.
HELP-Link has built relationships with large local employers such as manufacturers and health care providers, said Heather O’Loughlin, executive director of the Montana Budget & Policy Center, a nonprofit group that examines budget and tax issues. O’Loughlin said a dip in participation since 2021 is evidence that the program has moved many participants into stable jobs.
Caffero, the Democratic lawmaker, agreed.
“The program was doing exactly what we intended. People get jobs and jobs with benefits, jobs where they make a living wage, because they have education and training through HELP-Link,” she said. “That’s the goal. We don’t want the [Medicaid] rolls to go up.”
Buttrey noted that prior to the pandemic, Montanans stayed on Medicaid for an average of less than two years. “We’ve given people some job skills,” he said. “We’ve gotten them preventative care and help with addiction.”
Despite federal warnings, red and blue states aggressively cull Medicaid rolls
Robin Rudowitz, who oversees Medicaid research at KFF, a nonpartisan health research organization, praised Montana’s program for encouraging people to find a job — and get off government assistance — without denying them health care while they do it.
She contrasted HELP-Link with the strict work requirements Arkansas briefly had in place for Medicaid recipients during the Trump administration, before a federal court struck them down. Those rules knocked roughly 18,000 people off the rolls. “Arkansas was really the only state that actually implemented to the point of where individuals were disenrolled for failing to comply,” she said.
Rudowitz and other health experts also have been critical of Georgia’s Pathways to Coverage program, launched last summer, which extended Medicaid coverage to some low-income Georgians on the condition that they work or participate in another qualifying activity 80 hours each month. Under that program, which is not considered full expansion under Obamacare, 4,000 people have gained coverage, out of the roughly 350,000 who would qualify based on their income.
Georgia Republican Gov. Brian Kemp has defended the program and blamed the Biden administration for its slow start. The program is set to expire next fall, but several months ago, Georgia sued the federal government in a bid to extend it.
“It’s fiscally foolish, and anti-family,” Georgetown’s Alker said of the Georgia program. She noted that the state is leaving federal dollars on the table by eschewing a full-fledged expansion under Obamacare.
“It’s not been a pathway to coverage for anybody,” she said.
Historian and author Marc Johnson gives a book talk next month about Burton K. Wheeler, “one of the most powerful politicians Montana ever produced,” as part of the Montana Historical Society’s lecture series.
Johnson will speak from 1 p.m. to 2 p.m. Wednesday, Jan. 8, at Touchmark, 915 Saddle Dr. in Helena. He will talk about his book, “Political Hell-Raiser: The Life and Times of Senator Burton K. Wheeler of Montana.”
“(Wheeler) came of political age amid antiwar and labor unrest in Butte, Montana, during World War I, battling Montana’s powerful economic interests and championing farmers and miners as a crusading United States attorney,” said the announcement from the Montana Historical Society. “Wheeler went on to become one of the most influential, and controversial, members of the United States Senate during three of the most eventful decades in American history.”
Also in January, author and University of Montana archaeology professor Douglas MacDonald will discuss his “Land of Beginnings: The Archaeology of Montana’s First Peoples.”
The book talk takes place from 6:30 p.m. to 7:30 p.m. on Thursday, Jan. 16, at the Lewis & Clark Library, 120 S. Last Chance Gulch in Helena.
“While researchers have learned a great deal about the origins of the first people to call this region home, questions remain about which route or routes they took and when they made this journey,” said the Montana Historical Society about the book talk.
The organization also said the Original Governor’s Mansion will be open for free guided tours at noon, 1 p.m., 2 p.m. and 3 p.m. on Thursday, Dec. 26, and on Saturday, Dec. 28.
“The Queen Anne-Style mansion will be decorated for the holiday season through the weekend with surprises for visitors of all ages,” said the announcement.
For more information, contact Darby Bramble at [email protected].
On a frosty morning in late December, Marce Hoffman backs two huge draft horses out of a barn at the historic 320 Ranch south of Big Sky.
“Step up, step up,” Hoffman instructs the horses as he maneuvers them toward a waiting sled. It’s time to take the animals out for a turn on a trail they’ll know well by the end of the winter season. They’ll tread the path up to seven days a week during the holidays and five days a week after that. The animals strain in their harnesses, eager to pull and run.
“They’re fresh. They won’t be fresh come New Year’s, though; they’ll be all muscled up, ready to go,” said Hoffman.
MTN News
The 320 has a long history. It was homesteaded as two separate ranches more than 125 years ago.
“1912 they combined them to form 320 acres That’s how the ranch became known as the 320,” explained Hoffman as he practiced the history lesson he gives while narrating the ride through the high, narrow valley the ranch is nestled in, just outside the boundary of Yellowstone National Park.
In 1936, Bozeman doctor Carolyn McGill purchased the ranch.
Hoffman said, “She fell in love with this area on different hunting trips, trips down into the Yellowstone Park.”
You might recognize McGill’s name from somewhere else.
“Caroline started the Museum of the Rockies in Bozeman; was actually called the McGill Museum when it first opened up,” said Hoffman.
Current owner Dave Bass purchased the ranch in 1985.
Hoffman explained that’s when the ranch really began to grow into a tourist Mecca. He said, “He (Bass) bought it up from a 20 gust capacity over 200 that we have today.” He pointed to cabins that drifted by, framed by the mountains and the Gallatin River. It’s the view guests get as they take a one-hour trail ride in the sleighs. Hoffman ticked off the sights: “You get to see Cinnamon Mountain, Burnt Top Mountain. We’ll be able to see the Spanish Peaks when we go along the Gallatin here. Looking back you’ve got a view of Monument.”
MTN News
As he drives onto a flat, straight stretch of the trail, the horses get frisky. “These guys are gonna air out right here,” he cautioned, just as the horses break into a run. It demonstrated the challenge of managing big Percheron horses around guests.
“Our number one priority is keeping everybody safe. So we always have to be constantly looking at the equipment. As far as the people, probably the hardest part is herding them up and getting them on the sleighs,” Hoffman laughed as he allowed that it is probably harder to manage the passengers than the animals.
Sitting next to him, Head Wrangler Logan McDaniel said she enjoyed working at the ranch.
MTN News
“I like, of course, to drive and work with the horses but also meeting people from all around the world. You get to meet people from all different parts of life, all kind of different places,” she said. “They’re here for vacation. You get to kind of realize a little bit of people’s life story. It’s pretty cool just to meet different people.”
And the horses?
Hoffman said, “We’re looking for good disposition, you know. We’re not looking for heavy pullers we’re just looking for horses that are pretty docile and easy-going horses. They’re not gonna win any pulling competitions here.”
But these workhorses are no slouches.
“We’ll pull 18 people no problem and these guys are big horses,” said Hoffman.
He said that translates to about 18 hands and nearly 2,000 pounds each. As the horses cool down after their workout, Hoffman wiped them down and explained how these animals cope with the harsh winters at the ranch.
“You know those horses are on hay, you know free choice grass hay and water. They do pretty well. We’ve got a lean-to for them to get out of the wind. But for the most part, you know, they’re pretty hearty animals,” he said.
MTN News
By late afternoon, as dusk descends on the ranch, guests begin to wander toward a pair of the big sleighs. They board the blanket covered seats for a ride out to the other end of the valley where a wood-floored canvass tent awaits. It’s heated and features a bar serving snacks, hot cocoa, cider, and more. A fire crackles in a pit surrounded by seats outside. After a bit of rest, the passengers will climb back into the sleds for a ride back to the ranch restaurant.
Taking in the view around them, Hoffman and McDaniel reflected on their jobs. Hoffman said, “There’s a lot of people that never seen a horse or been around horses, so it’s a good opportunity to you know, to introduce them to the horses.”
McDaniel added, “It’s cool watching people fall in love with the horses. That’s why I kind of do this. It’s to see people fall in love with horses like I do.”
MISSOULA — Montana State’s path to Frisco, Texas, for the FCS national championship has been built by Treasure State natives.
For Rylan Ortt, Adam Jones and Zac Crews, that road started with the decision to become Bobcats — and spurn the hometown Montana Grizzlies — after playing high school football at Missoula Sentinel.
Tom Wylie / MTN Sports
“Rylan was the first guy to grow up a Griz fan and make that jump over to Bozeman for a lot of different reasons,” Sentinel football coach Dane Oliver told MTN Sports. “And so that kind of laid the foundation. And I know Zac and Adam both looked up to Rylan.
“You know how recruiting works, if they’re having a positive experience wherever they’re at, it helps when they hear from a kid that they trust and know.”
Ortt joined Montana State in 2019 after a stellar Sentinel career playing quarterback and throwing the javelin. As the Spartans’ QB, Ortt threw for 2,098 yards and rushed for 750 yards as a senior in 2018.
In the javelin, he won the 2019 Class AA state championship with a throw of 208 feet, 8 inches.
Once in Bozeman, Ortt transitioned to safety. He redshirted in 2019, and the 2020 season was canceled due to the COVID-19 pandemic. In the four years since, he has emerged as one of the leaders on a defense full of Montana guys.
This season, he leads the Bobcats with 75 total tackles. He’s also caught one interception and forced and recovered a fumble.
“He sacrificed a lot for our (Sentinel) program just having to play quarterback,” said Oliver, who played for the Grizzlies and was a member of their last national title team in 2001. “And hopefully that’s helped him being a safety, and maybe the knowledge you gain from the quarterback perspective has allowed him to have success at that level.”
While Ortt has been a stalwart in MSU’s secondary, Jones has had a breakout season on offense. He burst onto the scene in the Bobcats’ season-opening come-from-behind win at FBS New Mexico when he rushed for 167 yards, including a 93-yard touchdown that sparked the fourth-quarter comeback.
Jones this season has become the most prolific freshman runner in program history, rushing for 1,134 yards and 14 touchdowns. Against Idaho in the quarterfinals of the FCS playoffs, Jones accounted for 95 yards and four touchdowns with starting running back Scottre Humphrey sidelined.
“He’s got all the traits of what it takes to be great,” Oliver said of Jones. “You know, (Jones is successful) maybe a little earlier than I expected. I think the thing that Adam had going for him (in high school) was he was a three-sport athlete. You know, he was a heck of a baseball player, did hockey and football.
“He was always physical. … He’s got the hockey nature, so he’s not afraid of contact. But he’s put on some weight. He can finish runs, always falls forward, he’s got great vision. He’s got all the qualities of a back.”
Slim Kimmel / MTN Sports
Jones, Crews and fellow Cats Dylan Rollins and J.J. Dolan each played a part in helping Sentinel win Class AA state football championships in 2020 and 2021. Prior to the 2020 title, the Spartans’ last championship came in 1972.
Crews, a sophomore, has turned into a contributor on the defensive line with 24 total tackles and 2.5 sacks.
Dolan is a redshirt freshman, and Rollins, the 2020 Gatorade Montana player of the year and a 2021 Sentinel grad, is a freshman after beginning his college career at BYU and serving an LDS mission.
Now they’re all part of an MSU program aiming to end its own drought and win its first national championship since 1984.
“It’s fun to see them go on to be successful, not just the ones that play college football,” Oliver said. “It’s made me realize why I do this. It takes a lot of time and energy to coach high school football.
“So, just to see them grow into young men and have success and be fulfilled in it, whatever career they choose, and those guys are doing it on a public stage, and so obviously super rewarding for myself and all our staff to see the success they’re having.”
Montana State (15-0) will play North Dakota State (13-2) for the FCS national championship on Jan. 6.
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