Costs vary in Republican, Democratic plans to expand Medicaid

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HELENA, Montana — Two proposals to expand Medicaid in Montana would have drastically different outcomes on state finances.

Democratic Gov. Steve Bullock's plan to put an additional 65,000 Montanans on Medicaid would, over the next four years, be funded solely by the federal government and save the state $80 million. Beginning in 2020, the then-$500 million annual expansion would be funded 90 percent by the feds and 10 percent by the state.

A Republican counterproposal heard in the Legislature last week would immediately cost the state more than $20 million annually and cover one-sixth the people. But Republican Rep. Nancy Ballance says House Bill 455 is a backup to cover certain needy people in case the larger expansion fails the statehouse, like it did last session.

Federal funding would not be provided in as great a proportion to the Republican plan because it expands only existing services to disabled people and extremely poor parents.

Except 800 disabled people on a waiting list for special services, Bullock's proposal would cover everyone that Ballance's measure would plus tens of thousands more low-income people without health insurance.

"Mine is only trying to cover this group that is the poorest of the poor and continue to fall through the cracks and will again if the governor doesn't get his all-or-nothing plan," Ballance said Monday.

The Republican measure was originally touted as an alternative to the Democratic one. Bullock's Budget Director Dan Villa calls the Republican proposal an excuse not to expand coverage or provide additional services.

"By expanding Medicaid and accepting the 90-10 (federal funding) match rate, you get a lot of the mental health services that they're proposing to fund with the state general fund," Villa said of Republicans.

About 150,000 people in Montana are currently enrolled in Medicaid, according to the Centers for Medicare & Medicaid Services. The state pays one-third of the more than $1 billion cost.

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