Medicaid and abortion top health agenda for Montana lawmakers

Montana lawmakers said lowering costs and expanding patient access will be their top health care goals for the new legislative session. But they also will have to contend with making changes to Medicaid, a management crisis at the Montana State Hospital, and proposals to regulate abortion.

Republicans, who hold a veto-proof majority, said they will focus on three areas of health care: transparency, costs, and patient options.

Party leaders aim to keep "taking small bites that are moving the ball in the right direction on those three big things," Senate Republican spokesperson Kyle Schmauch said.

Democrats, who are the minority party and need Republican help to pass their bills, identified lowering health care costs, protecting Medicaid coverage, and preserving reproductive freedom as their priorities.

As the 90-day Montana session enters its second week, here are some of the top health issues on the agenda:

Expanding patient access

Expanding telehealth and making it easier for qualified providers from outside the state to practice in Montana are two ways Republican Gov. Greg Gianforte proposes to improve health care access, said spokesperson Brooke Stroyke.

House Speaker Matt Regier (R-Kalispell) agreed that telehealth is key to improving access. Republicans plan to build on a law passed in the 2021 session that made permanent some of the pandemic-driven emergency regulations that loosened restrictions on telehealth.

Schmauch said legislators will consider spending proposals to expand Montana's broadband reach to make telehealth a viable option for more people, particularly rural residents.

Other proposals meant to give rural patients with limited access to care more options are planned, such as allowing physicians to dispense prescription drugs to patients, and allowing pharmacists to prescribe certain drugs, Schmauch said.

Medicaid

Eleven Montana nursing homes announced closures in 2022, with officials citing staffing shortages and low Medicaid reimbursement rates as the primary reasons for the industry's ongoing struggles.

Lawmakers will debate raising reimbursement rates for nursing homes and many other types of health providers after a state-commissioned study found they were too low to cover the cost of care.

"Increasing provider rates at the study's recommended level will ensure a strong health care workforce and should be a priority for this legislature," said Heather O'Loughlin, executive director of the Montana Budget and Policy Center, a nonprofit organization that analyzes the state budget, taxes, and economy.

Gianforte's budget proposal includes reimbursement rate increases that fall short of what the study recommends. A bill by Rep. Mary Caferro (D-Helena) would base provider rates on the study's findings.

Federal rules dictated that anybody enrolled in Medicaid could not be dropped from the program during the public health emergency. But the omnibus spending bill recently passed by Congress allows states to begin reviewing the eligibility of their beneficiaries in April, and millions of people across the U.S. are at risk of losing coverage as a result.

"That will have an inherent outcome of removing people who qualified for Medicaid but because of this process being so complicated, they'll lose it," Caferro said.

Caferro said she plans to introduce legislation that restores 12-month continuous eligibility for adults enrolled in Montana Medicaid. The measure is likely to be opposed by legislative Republicans and Gianforte, who co-signed a letter to President Joe Biden in December saying the public health emergency had artificially expanded the Medicaid population.

Montana State Hospital

The Montana State Hospital lost its federal accreditation after a spate of injuries and deaths, making management of the psychiatric hospital and the availability of behavioral health services a top priority of the session.

Stroyke said Gianforte's two-year budget plan, which is a starting point for legislative budget writers, includes $300 million for the state hospital and for expanding access to intensive behavioral health care across the state.

Legislators are considering measures that would shift care for some patients from the state-run hospital to community-based health services. Regier said moving more public health services from state institutions to community providers would relieve some strain on facilities like the Montana State Hospital.

Abortion

Lawmakers from both parties have filed more than a dozen bill draft requests dealing with abortion. One from Regier would restrict the type of abortions that can be performed in the state, and, at the other end of the debate, a proposal by Sen. Ryan Lynch (D-Butte) would codify abortion access in state law. The Gianforte administration also recently proposed an administrative rule that would make it more difficult for women to have an abortion paid for by Medicaid.

But the Republican majority is restricted from enacting a sweeping abortion ban in the wake of the U.S. Supreme Court's 2022 decision to overturn Roe v. Wade. That's because a 1999 Montana Supreme Court ruling determined the state constitution's right-to-privacy protection covers abortion access. The state is seeking to overturn that precedent after a judge blocked three anti-abortion laws passed by the 2021 legislature.

Hospital oversight

Lawmakers also will consider proposals to increase oversight of the way nonprofit hospitals report community benefits.

State health officials have wanted to set standards for the charitable contributions those hospitals make in exchange for their tax-exempt status. A KHN investigation found that Montana's nonprofit hospitals spent about 8% of their total annual expenses on charity benefits in 2019, which is below the national average.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.