Healthcare (Medicaid)

This bill directs Montana's Department of Public Health and Human Services to stop enrolling new individuals in the expanded Medicaid program for able-bodied adults starting September 1, 2025, while allowing those already enrolled to continue coverage. The state will apply for a federal waiver to maintain funding for existing participants and may implement additional program requirements such as biannual eligibility reviews and lifetime benefit limits if federal funding decreases. The legislation also sets a termination date of June 30, 2025, for the current waiver and includes provisions for the program to end entirely once all enrolled participants have transitioned out of the expanded coverage.

This bill revises Montana's Medicaid expansion program by introducing new fees and community engagement requirements for participants. It requires individuals aged 19 to 55 to complete 80 hours of work, education, or community activities each month to receive coverage, while also establishing taxpayer integrity fees for those with significant assets like excess real estate equity or multiple vehicles. The legislation creates a monthly fee of $100 plus additional charges based on asset value above certain thresholds, and imposes fees on nonprofit organizations with Medicaid-eligible members. These changes aim to maintain program integrity by linking benefits to active participation and limiting access for those with substantial financial resources.

SB 62 would end Montana's Medicaid expansion program for able-bodied adults by prohibiting new enrollments after August 31, 2025, while requiring the Department of Public Health and Human Services to seek a federal waiver to maintain funding for current participants. The bill directly affects individuals enrolled in Montana's Medicaid expansion program who are able-bodied adults, preventing them from joining after the 2025 deadline. Key mechanisms include a strict enrollment cutoff date, a requirement for the department to apply for federal funding continuity, and authorization to implement program integrity measures like biannual eligibility reviews. The bill does not change coverage for individuals with specific health needs or those already enrolled continuously before September 1, 2025.

HB 687 revises the age range for expanded Medicaid participants who are required to engage in community engagement activities. Previously, participants aged 19 to 55 were subject to this requirement. This bill extends that upper age limit, now requiring individuals from 19 to 62 years old to participate. Affected participants must complete 80 hours per month in activities such as employment, education, work training, or community service, unless they qualify for an exemption. This change directly impacts expanded Medicaid recipients between the ages of 56 and 62.

This bill (LC 2924) would have prohibited the use of public funds - such as state or local government budgets - for gender-affirming surgeries. It would have directly affected transgender individuals relying on public healthcare programs (like Medicaid) and healthcare providers accepting public funding. The bill's key provision would have banned state and local governments from paying for these surgeries using taxpayer money. However, the bill died in committee on May 27, 2025, and never became law.

SB 199 revises Montana's Medicaid expansion program (the Montana HELP Act) by introducing monthly "taxpayer integrity fees" for participants meeting specific asset thresholds. It requires fees based on excess real estate value ($5,000+ above homestead limits), vehicle equity ($20,000+ combined value), or agricultural land taxable value ($1,500+ annually), with a base fee of $100 plus $4 per $1,000 over limits. The bill also updates community engagement rules, mandating 80 monthly hours of work-related activities for 19-55-year-olds (with exemptions for medical conditions, caregivers, students, and others). These changes directly affect Medicaid expansion participants owning significant assets or required to meet work participation standards.