Montana weighs expanding Medicaid rolls

Matt Volz, Associated Press

HELENA, Mont. (AP) -- Montana lawmakers are trying to decide whether it's worth spending up to $119 million to expand the state's Medicaid program to include as many as 57,000 more people now that a U.S. Supreme Court decision has given them the option.

The high court upheld most of President Barack Obama's health care law in June, but it also gave states the choice of saying no to a 2014 Medicaid expansion meant to cover to about 16 million additional people.

A decision by Montana legislators, who don't meet in full session until January, won't be easy because of the unanswered questions left by the high court's ruling, a panel of experts told an interim committee of lawmakers on Monday.

The four consultants, who are guiding several states through their options in the wake of the Supreme Court decision, advised committee members to conduct a thorough study to find out how much an expansion would cost the state.

They also told the lawmakers to think about whether there are enough doctors to handle the influx of new patients and whether people would drop their private insurance to join the Medicaid rolls.

They encouraged the lawmakers to use the expansion as an entry point to negotiate with the federal government for more control over its program and spending. But they warned not to expect much guidance from the federal Centers for Medicaid and Medicare anytime soon.

"A lot of these things won't be clear until after election," said Jim Hardy of Deloitte Consulting LLP.

Lawmakers heard an analysis by Gregg Davis of the University of Montana Bureau of Business and Economic Research, who estimated between 47,000 and 55,000 more people would be eligible if Montana expanded its Medicaid program.

The cost to the state could be between $100 million and $119 million by 2020, according to Davis' analysis.

Several people who attended the meeting said they supported an expansion of Medicaid rolls.

"Failing to expand will be a missed opportunity for health care for many Montanans," said Sarah Wilhelm of the Montana Budget and Policy Center.

Jean Branscom, executive vice president of the Montana Medical Association, sounded a more cautious note.

A physician shortage exists in many parts of the state, so any expansion would have to be planned so it is not at the expense of patient access and provider reimbursement rates, she said.