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December 5, 2024
Montana was among a few states to approve Medicaid expansion for only a few years after the federal program expanded under the Affordable Care Act. Legislators first expanded Medicaid eligibility for low-income Montanans in 2015, and again in 2019.
Renewal is up again in 2025 with newly appointed leaders of the Republican majorities in the state House and Senate. The expanded program currently insures roughly 77,398 people.
Incoming Senate President Matt Regier, R-Kalispell, has some history with Medicaid expansion. He voted against renewing the program in 2019 and has been clear about his concerns. He told the Daily Inter Lake earlier this year that the Medicaid program has grown too much as federal health programs expanded during the first years of the pandemic, though enrollment in Montana is again below pre-pandemic levels.
Incoming House Speaker Brandon Ler, R-Savage, wasn’t in the Legislature in 2019. The expansion debate in the coming session will be his first.
Both men tell Capitolized their caucuses won’t be united on an outcome.
Regier said if the votes aren’t there to end Medicaid expansion, then his personal effort will be to reshape the program.
“Leadership in the Senate is conservative. I don’t want to speak for all of them, but I think we need to come to a reconciliation with ourselves on our welfare spending and what is it there for. What was traditional Medicaid for? Do we need expansion?” Regier said. “Where does welfare stop? When does it stop becoming a safety net and turn into a lifestyle? At least for me, that’s going to be part of my debate as, openly, I’m going to be a no vote on Medicaid.”
Republicans held the majority in the Legislature both previous times Medicaid expansion was approved. Bills to renew the program will be carried by Republicans. Ler said he expects Republican Ed Buttrey will carry the renewal bill, which will be one or two pages long and simply keep the program going.
“Our caucus, we fall on both sides. There’s definitely a group of people who are heavily in favor of [expansion]. And there is another group that is the conservative [contingent] of the caucus,” Ler said. “As leadership, we can’t really pin down one side or the other, because we’ll be a fractured caucus. What we’re after is to have good dialogue, a diverse conversation. There’s going to be a plethora of bills, whether they come out of the House or the Senate, that are going to add another layer to the Medicaid expansion topic.”
That broader discussion is likely to include consideration of work requirements for participants in an expanded Medicaid program, and possibly drug testing, Ler said. It still isn’t clear what changes to Medicaid might come from President Donald Trump’s incoming administration.
States that expanded Medicaid after the passage of the Affordable Care Act in 2012 offer coverage to adults with incomes up to 138% of the poverty level, which is roughly $20,782 for an individual, or $38,630 for a family of three, according to federal health data. The federal government picked up the tab until 2020, when states began paying for 10%. The program provides comprehensive health coverage — preventative care, prescription drugs, hospital services — to those enrolled.
Medicaid expansion enrollment in Montana has declined sharply, particularly for childhood Medicaid, as the state enacted a Medicaid “unwinding” post-pandemic, as previously reported by Montana Free Press. At its peak in 2023, participants in the expanded Medicaid program numbered 125,035. Nine months into 2024, the number had decreased to 77,398.
Similarly, the combined number of traditional Medicaid participants, both adults and children, plus enrollees in expansion, has also dropped sharply, from 302,707 at its peak in 2023 to 204,796.
Regier said shrinkage of the program addressed some, but not all, of his concerns about the size to which Medicaid grew during the pandemic. He still opposes renewal of the expanded program but said he will work to trim it further if expansion isn’t repealed in the 2025 session.
“If there aren’t enough no votes there to end the program, then I’m also looking at how we can make the program better,” Regier said. “Even if we don’t touch the consumers, how can we hold the hospitals accountable? There’s different ways to do that.”
—Tom Lutey
A Blast with a Past
Legislators met Dec. 3 to set the ground rules for the 2025 session. One of the proposals was to increase the number of floor votes necessary to “blast” a bill from committee in the state Senate. Judiciary Committee Chair Sen. Barry Usher, R-Laurel, said it should be harder to resurrect a bill a committee has killed.
“I remember there was one bill of mine that actually was in the committee that got heard three times, or they tried to bring it off the table, and it didn’t. Well, you know, that’s the merits of my bill. If my bill didn’t make it, my bill didn’t make it,” Usher said. “But when we can blast something just with the [51%] straight to the floor, when the committees did a lot of work on a lot of bills, I just think it’s insulting to the work that they did, and I think that we need to raise the bar a little bit.”
Usher wanted to raise the number of votes to blast a bill in the Senate to 28. The effort failed.
“I think the basic principle in a Democratic Republic is that the majority should rule. And I don’t think with having any type of filibuster rule that would require more of a majority does the public get any better service,” said Sen. Daniel Emrich, R-Great Falls.
—Tom Lutey
That’s Senator Kerr-Carpenter
Democratic Rep. Emma Kerr-Carpenter, D-Billings, was selected by Yellowstone County Commissioners this week to replace Kathy Kelker in the state Senate. Kelker submitted her letter of resignation to the County Commission in the weeks following the election.
House veteran Kerr-Carpenter, first elected to the chamber in 2018, was an easy choice, said Becky Riedl, who chairs the Yellowstone County Democratic Party.
“Really do give the county commissioners a lot of credit, because I really do feel like they are selecting the person that they think is going to really be a good candidate to represent Billings and Yellowstone County,” Riedl told Capitolized.
The two other Democrats considered for the job were Mark Nicholson and Rudolf Haden.
Riedl said the party will meet Dec. 9 to select three nominees to replace Kerr-Carpenter as House representative for midtown Billings.
—Tom Lutey
End Quote
“I’m happy to see that this proposed ban failed and am grateful for my colleagues — particularly my Republican colleagues — who recognized this as a distraction from the work we were elected to do.
I’m ready to represent my constituents & look forward to working on behalf of Montana.”
—Rep. Zooey Zephyr, D-Missoula, responding on X to a Joint Rules Committee vote this week against a proposed bathroom rule targeting trans lawmakers.
On Background
- Conservative groups are working to undermine support for Montana’s Medicaid expansion in hopes the state will abandon the program.
- In 2023, following a public protest of Rep. Zooey Zephyr being banned from floor debates, the Montana House of Representatives voted on party lines to bar Zephyr from the chamber’s floor, anteroom and gallery.
- Shortly after the general election, Republican legislators selected Brandon Ler to be House speaker and Matt Regier to be Senate president, along with a full slate of leaders for the 2025 Legislature.