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Big Sky Medicaid Expansion Comes at a Big Cost

Montana has a unique opportunity.

Montana gets to decide if it wants to keep Medicaid expansion or ditch it completely. The answer is obvious: Run far, far away.

States that have expanded Medicaid to include able-bodied adults have largely felt the strain of over-enrollment and overextended budgets, and Montanans have not been spared the burden. Six years into Montana’s Medicaid expansion, one out of every four dollars spent in the state goes to fund Medicaid, and as a result, other state priorities are feeling the squeeze.

Enrollment and spending are out of control—other priorities are suffering

Advocates for Medicaid expansion estimated that no more than 59,000 able-bodied adults would ever enroll if the state were to expand, yet the number of able-bodied adults on the program has since toppled 125,000. According to a new report from the Foundation for Government Accountability, able-bodied adults on Medicaid now represent 39 percent of the state’s total Medicaid enrollees—outnumbering even the number of low-income children that traditional Medicaid covers.

It’s no wonder that state spending on Medicaid has taken on a life of its own. According to the report, in the 15 years before Montana’s adoption of Medicaid expansion, Medicaid spending had grown by less than two percent. But in the six years after Medicaid expansion, state spending on Medicaid grew six times as fast. Total Medicaid spending went from $1.1 billion in 2015 to $2.3 billion by 2022.

This growth in Medicaid spending has crowded out other budget priorities, and the new report gives us a startling example. Whereas state spending on K-12 education represented nearly 21 percent of the state budget in 2000, by 2022 it represented just 15.3 percent—a 26 percent drop.

Montana built itself an escape hatch

Expanding Medicaid to include able-bodied adults who are fully capable of supporting themselves may have been a priority for blue states like California. After all, California was an early adopter of Medicaid expansion and has since expanded coverage even further to include non-citizens. But Medicaid expansion in Montana has been a very different story.

Policymakers in Montana debated Medicaid expansion for years, and only agreed to it in 2016 with stipulations that the state legislature be forced to provide reauthorization for it again in the future. In short, they wanted lawmakers to routinely justify Medicaid expansion’s continuation. So, while it might take an act of God to overturn Medicaid expansion in states like California, Montana’s good foresight has awarded the state with an opportunity to roll back this failed policy.

Medicaid expansion will continue to rack up the bills until lawmakers refuse to reauthorize it again. Record numbers of able-bodied adults on Medicaid will continue to crowd out other state priorities and put truly needy individuals on the back burner.

Montana has enough West Coast values to contend with these days, with the influx of wealthy Californians impacting everything from our housing market to public river access. Restoring sanity to the state’s budget and refocusing Medicaid as a safety net for the truly needy is a chance for Montana to differentiate itself and stand firm in support of the values that make it the Treasure State.

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