ELENA, Mont. – Montana lawmakers said lowering costs and expanding patient access will be their top health goals for the new legislative session. But they will also have to deal with changes to Medicaid, a management crisis at Montana State Hospital and proposals to regulate abortion.
Republicans, who hold a veto-proof majority, said they would focus on three areas of health care: transparency, cost and patient options.
Party leaders aim to continue “taking little bites that are moving the ball in the right direction on these big three things,” Republican Senate spokesman Kyle Schmauch said.
Democrats, who are the minority party and need Republican help to pass their bills, have identified lowering health care costs, protecting Medicaid coverage and preserving reproductive freedom as priorities.
As the Montana 90 Day 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 out-of-state providers to practice in Montana are two ways Republican Gov. Greg Gianforte is proposing to improve access to health care, spokeswoman Brooke Stroyke said.
House Speaker Matt Regier (R-Kalispell) agreed that telehealth is the 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 eased restrictions on telehealth.
Schmauch said lawmakers will consider spending proposals to expand Montana’s broadband reach to make telehealth a viable option for more people, especially rural residents.
Other proposals intended to give rural patients with limited access to care more options are planned, such as allowing doctors to dispense prescription drugs to patients and allowing pharmacists to prescribe certain drugs, Schmauch said.
Eleven nursing homes in Montana have announced closures in 2022, with officials citing staff shortages and low Medicaid reimbursement rates as the main reasons for the industry’s ongoing strife.
Lawmakers will debate raising reimbursement rates for nursing homes and many other types of health care providers after a state-commissioned study found they were too low to cover the cost of care.
“Raising provider rates to the level recommended by the study will ensure a strong health care workforce and should be a priority this legislature,” said Heather O’Loughlin, executive director of the Montana Budget and Policy Center, a nonprofit organization for-profit that analyzes the state budget, taxes and the economy.
Gianforte’s budget proposal includes reimbursement rate hikes that fall short of what the study recommends. A bill by Rep. Mary Caferro (D-Helena) would base vendor rates on the study’s findings.
Federal rules stated that anyone enrolled in Medicaid could not be barred 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 in the United States are at risk of losing coverage as a result.
“This will have an intrinsic result of removing people who have qualified for Medicaid, but because of this complicated process, they will lose it,” Caferro said.
Caferro said he 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 has artificially expanded the Medicaid population.
Montana State Hospital
Montana State Hospital lost its federal accreditation after a surge in injuries and deaths, making the management of the mental 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 the legislative budget writers, includes $300 million for the state hospital and to expand access to intensive behavioral health care across the state. state.
Lawmakers are considering measures that would shift care for some patients from the state hospital to community health services. Regier said moving more public health services from state institutions to community providers would ease some strain on facilities like Montana State Hospital.
Lawmakers on both sides have filed more than a dozen requests for abortion-related bills. One from Regier would limit the types of abortions that can be performed in the state, and at the other end of the debate, a proposal from Sen. Ryan Lynch (D-Butte) would codify abortion access into state law. The Gianforte administration also recently proposed an administrative rule that would make it more difficult for women to get a Medicaid-paid abortion.
But the Republican majority is prevented from enacting a sweeping abortion ban in the wake of the US Supreme Court’s 2022 decision to overturn Roe versus Wade. That’s because a 1999 Montana Supreme Court ruling ruled that the state constitution’s right-to-privacy protection covers access to abortion. The state is looking to overturn that precedent after a judge blocked three anti-abortion laws passed by the 2021 legislature.
Lawmakers will also consider proposals to increase oversight of how nonprofit hospitals report benefits to the community.
State health officials wanted to set standards for the charitable contributions those hospitals make in exchange for their tax-exempt status. A KHN survey found that nonprofit hospitals in Montana spent about 8 percent of their total annual expenses on charitable benefits in 2019, which is below the national average.
Keely Larson is a KHN Fellow for 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 journalism and natural resources at the University of Montana.
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