Newly re-elected Montana Gov. Steve Bullock, a Democrat, is again trying to come up with a way to expand Medicaid despite opposition from the Republican-controlled state Legislature.
Bullock unveiled his latest plan to expand thprogram Nov. 17 as part of his proposed budget. He has unsuccessfully tried to get the GOP-led Legislature to agree to expansion in the past. A bill to expand the program to more than 70,000 individuals last year was blocked from leaving a House subcommittee.
Bullock is taking a different, more nuanced approach this year, however, according to Dan Villa, his budget director. The proposed Healthy Montana Plan would use federal money to contract with a private administrator, such as an insurance company, to process claims and run a network of physicians, hospitals and other providers to serve the newly covered population.
This model builds on one now used in the state for the Children's Health Insurance Program. It differs from a true managed-care model because the state would still have a say in how benefits are administered. Villa claims this is an approach that's not being used elsewhere.
Midterm elections Nov. 4 resulted in major turnover in the Legislature. Even though there is still a Republican majority in the House and Senate, there is now new leadership in both.
The Montana Senate picked Sen. Debby Barrett as its president. Republicans outnumber Democrats in that chamber 29-21. Lawmakers in the House picked Rep. Austin Knudsen as speaker. Republicans there have a 59-41 majority. The Legislature kicks off its new session Jan. 5.
“I will consider” Bullock's proposal, Barrett said. “I haven't seen it yet, but will take a look at it.”
Knudsen did not immediately return requests for comment, but has said in the past he is opposed to using federal funds to expand Medicaid.
Legislation would have to be passed for Bullock's plan to be adopted. If that were to happen, it likely wouldn't be until spring 2015. After that, state officials would have to get CMS approval for a waiver and put out a request for proposals for the third-party administrator. As a result, coverage wouldn't actually kick in until late 2015 or early 2016.
The Bullock administration has already been in discussions with the CMS about its ideas and the response has been positive, Villa said.
If Bullock's plan dies in the Legislature again, more Montanans will still get health insurance next year, argues Jean Branscum, executive vice president of the Montana Medical Association.
A variety of ideas from individuals in both parties have been explored during the recent interim session, Branscum said. They include using state general funds rather than federal dollars to provide more people with health coverage. A similar approach was taken in Wisconsin to expand coverage to childless adults under the federal poverty level.
Another idea being floated in Montana is to follow Arkansas' lead and purchase insurance for people between 100% and 138% of the federal poverty level.
“We are optimistic that some type of plan that provides health insurance to additional individuals will be implemented,” Branscum said.
Follow Virgil Dickson on Twitter: @MHvdickson