With Montana's Medicaid expansion on Trump's chopping block, what else is at stake? 

The consensus among many Montana commentators over the past few weeks has been that Congress' current tack on health care will leave tens of thousands of the state's most vulnerable residents at risk. Massive cuts to Medicaid proposed by the Senate would eliminate Montana's Medicaid expansion program, which currently covers an estimated 79,000 enrollees. The result, according to Montana Health Co-Op CEO Jerry Dworak, would be sizable increases in hospital costs and insurance premiums.

"If that goes away," he says of Medicaid expansion, "it's going to adversely affect the exchange."

As the Senate continues to haggle over health care, there's more at stake for Montana than coverage and premiums. The 2015 bill that expanded Medicaid also established a voluntary employment services program for new enrollees that is tied by statute to the expansion itself. Dubbed HELP-Link, the program offers Medicaid expansion enrollees the opportunity to participate in job training services through Montana's Department of Labor and Industry. HELP-Link also surveys new enrollees to collect information on participant demographics and barriers to employment.

The whole goal of that program, says Republican state Sen. Ed Buttrey, chief architect of the 2015 legislation, was to lift people out of poverty and eventually get some out of the Medicaid expansion program. "There's lots of businesses looking for skilled labor right now in Montana, and they're paying great dollars with benefits. We need to take folks that can match up to those skills, get them the training, get them in those jobs," he says.

According to DLI's latest figures, more than 1,900 people have received one-on-one employment services through HELP-Link since the program was implemented in January 2016. Nearly 80 percent of the program's participants have subsequently found employment, with the three most commonly pursued occupations being truck driver, nursing assistant and registered nurse. As DLI spokesman Jake Troyer wrote via email, "Registered nurses earn a median wage of roughly $60,000 in Montana, which would likely be enough to lift a family of five out of poverty and above the Medicaid expansion eligibility threshold."

Though the Senate's potential influence over Medicaid in Montana has generated widespread concern, Buttrey believes the state will also play a significant role in the program's future. The law stipulates that any reduction in federal funding for Medicaid must be resolved by state legislative action, increased premiums, or a combination of the two. Even if Congress fails in its current agenda, Montana's expansion program sunsets in 2019, at which point the Legislature will have to decide whether to renew it. HELP-Link, Buttrey says, could help make a strong argument for continuation next session.

"If all of a sudden we show, 'Oh my God, we're getting people out of poverty, we're satisfying our skilled worker shortage, we're getting more income tax, more people are buying homes' ... I don't care if you're Republican or Democrat. They're going to say, 'This is a great deal.'"

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