HELENA — As the Montana Legislature continued its second day of marathon debates ahead of Friday’s transmittal deadline, the state Senate voted one more time on Medicaid expansion.

(Watch the video to see more from Thursday’s debate on Medicaid expansion.)

Montana Seante debates Medicaid Expansion

House Bill 245 – the main bill to renew Medicaid expansion in the state – passed the Legislature last week. However, Senate President Sen. Matt Regier, R-Kalispell, said it was worth having one more discussion about how the program should be structured.

“Whether it’s this bill, this program, a lot of things that we do here at government, we need to stop and take a look at what’s the end goal,” he said Thursday.

Senators narrowly rejected Regier’s Senate Bill 334, on a 24-26 vote.

Regier argued his bill was “stackable” with the existing program, not in competition with it – but it would make significant changes. SB 334 would have required the state to ask for and receive a waiver from the federal government and implement “community engagement” requirements in order to offer Medicaid expansion. The current state law calls for community engagement – requiring those on Medicaid expansion to spend 80 hours a month on work, education, workforce training, volunteering or other approved activities – but federal authorities haven’t yet allowed the state to implement those requirements.

SB 334 also would have lowered the maximum income level to be eligible for Medicaid expansion, from 138% of the federal poverty level to 100%. Regier said that would mean about 14,000 people currently on the program would no longer be eligible, but he argued those people now have other options for health coverage, including getting insurance through the Affordable Care Act marketplace.

“Are we going to judge a program on how many people we can put on it, or judge a welfare safety net program as its success of not needing it anymore – how many people can be off of it and be self-sufficient to where we don’t even need that program anymore?” Regier asked. “To me, that is more of a definition of success.”

However, opponents of SB 334 said lawmakers had already weighed in on the Medicaid expansion program – by passing HB 245, which essentially continued it as it is currently. They said the bill would undermine a system that’s already working.

“This bill coming now is a fix that we really don’t need,” said Sen. Russ Tempel, R-Chester.

“What we are essentially doing is we are taking people who are working hard – they’re hard-working Montanans in our small businesses, in all of our communities who are trying to make things work – and we’re making it harder for them,” said Sen. Emma Kerr-Carpenter, D-Billings.

The Senate passed HB 245 30-20 on a final vote last Thursday. Earlier this session, senators also voted down Senate Bill 62, which would have begun phasing out the Medicaid expansion program.