Revise medicaid buy-in program to include children with disabilities
Summary
HB 881 revises Montana’s Medicaid buy-in framework to explicitly add children with disabilities as eligible participants, alongside the existing program for working individuals with disabilities. The bill amends multiple sections of the Montana Code Annotated to create a new pathway for children under 19 who meet disability criteria and family-income limits to receive Medicaid buy-in coverage, and it also updates related eligibility and rulemaking provisions in the broader Medicaid statutes.
The bill directs the Department of Public Health and Human Services to administer the expanded program, including setting eligibility standards, participant cost-sharing, and coordination with other state and federal disability-employment supports. It also includes an appropriation for the 2026 and 2027 fiscal years to fund the new coverage category, and it takes effect July 1, 2025.
Impact
HB 881 changes Montana Medicaid law by amending sections governing Medicaid administration, eligibility, and the Medicaid buy-in program. The most significant substantive change is the addition of children with disabilities to the buy-in program, with specific income thresholds, premium requirements for parents, and cost-sharing caps. The bill also extends and clarifies the Department of Public Health and Human Services’ rulemaking authority over Medicaid eligibility and administration, including provisions related to children, foster care, medically needy eligibility, and disability-related coverage. The appropriation provides state and federal funding to implement the expanded program.
Sentiment
The bill appears to have had generally favorable support in both chambers, passing committee and floor votes with clear majorities, though not unanimously. It advanced through House Human Services, House Appropriations, and both chambers’ floor votes, indicating broad legislative support for expanding coverage to children with disabilities. The final context notes that the bill was vetoed by the Governor, suggesting that executive branch support was not aligned with the Legislature’s approval.
Contention
The main points of contention likely centered on the cost of expanding Medicaid buy-in coverage and the policy choice to use state and federal funds for a new eligibility group. The bill includes a biennial appropriation and premium/cost-sharing provisions, which may have raised fiscal concerns among opponents. The recorded nay votes in committee and on the floor indicate some legislative resistance, likely from members concerned about program expansion, budget impact, or Medicaid policy design, while supporters emphasized coverage for children with disabilities and support for families.