Lawmakers vote to add 12 months of postpartum coverage to Montana Medicaid

The vote came as part of the House Appropriations committee’s opening work on the state’s $13.4 billion dollar budget, also known as House Bill 2. The committee will spend much of the week moving through state agency budgets, putting their own mark on work done previously this legislative session by budget subcommittees.

The state health department’s budget makes up nearly $8 billion of the overall state budget. The change to add 12 months of postpartum coverage was in Gov. Greg Gianforte’s initial budget proposal, but lawmakers on subcommittee focused on the Department of Public Health and Human Services instead opted for a less-expensive option to provide coverage for six months only to people who had a mental health or substance use disorder diagnosis.

“The first year is critical in maternal health. I can speak to that from experience,” said Rep. Emma Kerr-Carpenter, a Democrat from Billings, when bringing the amendment Tuesday to create the coverage. “I'm still not done with a full year after having my own child. It has been a wild year. This is something that we talk a lot about — the sanctity of human life in this state, and I think this is a really good step towards that.”

The amendment will add $1.9 million in general fund spending over the two-year budget and draw in $4.3 million in federal money. The six-month proposal lawmakers originally opted for would have cost approximately $910,300 in state funds over the two-year budget and $2.06 million in federal dollars.

The amendment passed on a 17-6 vote with bipartisan support.

Lawmakers made several other tweaks to the budget, including increasing the amount of money the state allows to flow from child support payments to families on the Temporary Assistance for Needy Families program, or TANF, up from $100 to $200.

The committee also reversed another budget subcommittee move that would have cut caseload estimates for Medicaid, which is the amount lawmakers set aside to pay for Medicaid based on guesses of how many people will be covered by the program and what kind of health care they’ll access. The committee also undid a 2% cut to caseloads for the Behavioral Health and Developmental Disabilities Division and Senior and Long-Term Care Division, and left a 1% cut to caseloads in the Health Resources Division, which includes hospitals, among other places. That change passed unanimously.

Other changes that passed included a 4% provider rate increase for inpatient hospitals. The amendment from Rep. Jane Gillette passed on a 17-6 party-line vote, with some Democrats concerned the change had too strict of provisions on requirements about upper payment limit reporting required by hospitals and possible fees that could be charged to hospitals with high cost-to-charge ratios.

Lawmakers also approved an amendment from Speaker of the House Matt Regier, of Kalispell, to stop money collected from the state tobacco tax to go into a fund that collects money from a hospital utilization fee paid by hospitals in the state. The money is used to draw down federal funds, which Regier said flow back to hospitals. Regier argued moving tobacco money to the hospital utilization fund was convoluted.

Democratic Rep. Mary Caferro, of Helena, argued that tobacco tax and settlement money was created in part to be devoted toward health care spending, which would include Medicaid, which she said the funding is being used to shore up.

Anaconda Republican Rep. John Fitzpatrick attempted to pass an amendment to further increase the rates paid to Medicaid providers, but that effort failed. A study done prior to the session recommended increases in those rates across the board, and the subcommittee had already upped the amount for those rates in the state budget above what Gianforte proposed.

There’s also a separate bill advancing from Caferro to fully fund the provider rate study beyond what even the subcommittee did.

Rep. Bob Keenan, a Big Fork Republican who chaired the budget subcommittee that increased the rates, said he opposed Fitzpatrick’s proposal because he was proud of what he called the historic and unprecedented work already done on the topic.

Democratic Rep. Connie Keogh, of Missoula, brought an amendment that would have added $9 million in state money in each year of the budget for the Best Beginnings child care program, but the effort failed.

The program helps families pay for child care and popular pandemic-era changes to lower copays and give stability in payments recently ended, which left parents and businesses in limbo. One effort to increase program funding and make changes to operations has already failed this session, though lawmakers heard another policy bill on the issue Tuesday.

Another effort, also from Keogh, would have put $8.9 million in state funding toward the Comprehensive School and Community Treatment program. Last session following frustrations over how the state health department navigated a change in funding allowed by the federal government, legislators moved the program to the Office of Public Instruction.

School districts said the change did not work well, and they’ve faced challenges coming up with their share of matching funds for the program. Keogh said her amendment would have helped them foot the bill, saying the program plays a vital role for students.

“If we don't find a way to provide money to help with this, most schools are not able to support the match dollars,” Keogh said, adding that the amendment would have treated CSCT like other Medicaid programs where the state puts up cash to draw down federal dollars.

But Keenan told lawmakers to resist the amendment, saying he has legislation that will be heard soon to overhaul the program.

“House Bill 822 is going to talk about a whole continuum of care. It's not going to be just CSCT. CSCT needs to be repackaged, rebranded, reworked, and become a better program,” Keenan said.

Another failed amendment from Caferro would have established 12 months of continuous eligibility for those covered by Medicaid expansion. The program was created with that provision, which lawmakers later removed. But it stayed in place during the pandemic and is set to expire in April when the state begins a process of redetermining the eligibility for everyone covered by Medicaid.

Caferro said Medicaid expansion is the “health care product for the working poor in Montana,” pointing to data that shows seven in 10 expansion recipients hold jobs.

Rep. Paul Tuss, D-Havre, said the program has helped keep the doors open for rural hospitals, but Rep. Jerry Schillinger, of Circle, said his rural hospital has not seen a benefit from the program.

The House Appropriations Committee will continue to take votes on the state budget over the next few days, in advance of it reaching the full House for debate in coming weeks.