Montana Senate reauthorizes ACA Medicaid expansion at the last minute...with work requirements

Montana didn't expand Medicaid under the Affordable Care Act until January 2016, and when they did so, the legislation was written with an automatic sunset date of June 30, 2019 unless it's expanded beyond that. Unfortunately, the ballot proposal to make Medicaid expansion permanent failed last November, which put the issue back in the hands of state lawmakers.

The good news is that the Montana state legislature did indeed finally vote to extend the program, which covers around 96,000 people, this week. The bad news is...well:

The bill to continue Medicaid expansion in Montana passed out of the state Senate Tuesday after teetering on the edge of a deadline for end of session negations.

The reauthorization of the health coverage program for low-income adults, packaged with new work and public service requirements for certain enrollees, passed 28-22 in its final Senate vote.

...The expansion bill, HB 658, now moves back to the House. Lawmakers there are expected Wednesday to debate changes made to the bill made by the Senate. Those include a 6-year sunset on the policy, meaning it will expire in 2025 unless another agreement to continue it is reached by the Montana Legislature.

...With 10 days left in the legislative session, Medicaid expansion must pass additional votes in the House before heading to Governor Steve Bullock’s desk.

It's my understanding that the Montana-flavored work requirement provisions isn't any better than other states which have pushed them through, but also no worse. While it sucks, it's apparently the best that the Dems could do under the circumstances and given the ballot proposal failure last fall. All of which is to say: Every election counts.

Of course, if the recent judicial rulings against work requirements end up being extended to Montana and other states, that could change the equation...either resulting in condition-free expansion or killing the Medicaid expansion programs altogether, depending on the specifics.

In the meantime, most of Montana's Medicaid expansion enrollees are likely to be on safe ground going forward...I hope.