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Montana governor will try again to expand Medicaid

Montana Gov. Steve Bullock (D)
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Montana Gov. Steve Bullock (D) said Monday that he will try once more to convince state legislators to accept federal money to expand Medicaid, an uphill fight in a state where the Affordable Care Act remains deeply unpopular.

Bullock’s proposal, which he dubs the Healthy Montana Plan, is based on an existing system that covers low-income children. That system, the Healthy Montana KIDS Plan, is government-funded but privately managed.

The plan would pay health-care providers at a higher rate than they receive from regular Medicaid, though not as much as they would receive from private insurers. A private insurer would administer the money, process claims and oversee a network of hospitals and providers to ensure new recipients are covered without overwhelming the system.

Bullock said his system would spur reforms to the state’s existing Medicaid program that Republicans want to see.

“It wouldn’t grow state government, thereby also affording us not only the opportunity to cover people, but also institute reforms and cost saving measures as well,” Bullock said at a Monday news conference.

Expanding the program would add about 70,000 low-income people to the state’s Medicaid rolls. Republicans who control the legislature blocked Bullock’s attempt to expand Medicaid under the ACA; Bullock stressed that this proposal is different from expansions in any of the 27 other states that have accepted federal money.

“No other state in the nation is using a similar model as we’re proposing today,” Bullock said Monday. “It’s a made-in-Montana way to accept federal funds, to expand health coverage to 70,000 working Montanans.”

Bullock said early conversations with federal officials, who would have to sign off on any amendments or alterations, have been encouraging. The fight will come within his state legislature: Republicans hold big majorities in both the state House and Senate.

Bullock’s budget [pdf] calls for spending a little more than $4.5 billion over two years, including $300 million in new infrastructure developments, another $300 million set aside for a rainy-day fund, a pre-kindergarten program and a tuition freeze within the Montana University System.