Despite concerns over potential actions by Congress and the Trump administration regarding Medicaid, Montana’s Republican-led legislature and GOP governor are prepared to keep the state’s Medicaid expansion program in place beyond its scheduled end date this summer. Lawmakers do not have time to wait for clearer federal guidance; they must decide before their session concludes early May whether to extend a June 30 deadline for the expansion program, which covers approximately 76,000 adults.
The prospect of significant changes ahead in the joint federal-state Medicaid program has led legislators and state representatives to consider how best to prepare. During a recent meeting of the budget subcommittee she chairs that oversees Medicaid funding, Republican state Rep. Jane Gillette highlighted this challenge: “What are our options for preparing?”
In Washington D.C., the U.S. House is crafting a budget bill aligned with President Donald Trump’s priorities, including $4.5 trillion to extend expiring tax cuts. A plan passed by the House Budget Committee on February 13 calls for cutting Medicaid spending over ten years by $880 billion under the committee overseeing various aspects of health care funding.
Proposals include federal work requirements for some Medicaid recipients and reducing the share of costs covered by the federal government, shifting more expenses to states. As noted by Robin Rudowitz, a vice president at KFF (Kaiser Family Foundation), if implemented, these changes would require states like Montana to either raise revenue or cut other spending areas in order to maintain current levels of Medicaid coverage.
Other states are also grappling with federal shifts. The South Dakota Legislature is considering asking voters whether to continue their Medicaid expansion if the federal contribution rate declines. In Idaho, a bill that outright repeals the program has been introduced but not heard; another bill making it contingent on specific federal limitations passed in the state House.
Montana and eight other states have trigger laws allowing them to end their expansion programs should the federal matching rate decrease. On February 10, the GOP-controlled Montana House of Representatives overwhelmingly approved a permanent Medicaid expansion program with a vote of 73-26. However, some Republicans remain cautious about how quickly potential changes from Washington could occur.
State Senator Jeremy Trebas emphasized aligning state policy with anticipated federal shifts when urging support for his bill to tighten work requirements and phase out the program if federal approval is denied. He predicted that HB 245, which passed earlier in the session, will move forward but also warned about possible faster-than-expected changes from Washington requiring a special legislative session.
Meanwhile, Republican State Senate President Matt Regier introduced a bill to limit Medicaid expansion eligibility and give the state health agency tools to manage spending or improve program integrity. Additionally, this bill would make the expansion contingent on federal approval of certain waivers, including work requirements, and call for lawmakers to vote on holding a special session if the federal Medicaid matching rate drops significantly before 2027.
Despite these varied approaches, many agree that preparing for potential future shifts in policy is crucial. Representative Ed Buttrey expressed doubt about how quickly such changes could occur but acknowledged the importance of planning comprehensively to ensure program stability and meet residents’ needs effectively.
