Montana could be a model as more GOP states weigh Medicaid work requirements. • Stateline

Montana could be a model as more GOP states weigh Medicaid work requirements.  • Stateline

Twenty years ago, Jeff Beisecker and his family returned to Great Falls, Montana, from a religious mission to the Philippines. Beisecker had no health insurance and no steady source of income, and neither did his wife. Fearing being left without coverage, Beisecker enrolled himself, his wife and their four children in Medicaid for nearly a decade while he worked his way up to a steady, full-time job.

The extra help made a difference for his family, 53-year-old Beisecker remembers. “And people might have looked down on us. It doesn’t really matter to me because it was there to help us along the journey.”

For Beisecker, Medicaid coverage was a springboard to stable work; now he’s helping others make that leap. As employment and training coordinator for Opportunities Inc., a Great Falls-based nonprofit, Beisecker connects Montana Medicaid recipients with job training, career guidance, transportation and child care. Opportunities Inc. is one of several nonprofits running a state-established voluntary program called the Health and Economic Livelihood Partnership Link, known as HELP-Link.

“When people come in, we can meet them and say, ‘Hey, maybe you can take this training that we can help pay for, and you can come out and make $28 or $29 an hour,’” Beisecker said.

A growing number of Republican-led states want to require Medicaid recipients to work, arguing it will help them rise out of poverty. Democrats and health care advocates note that most people on Medicaid already work full or part time. They argue that states should not deny health care to people who are out of work, especially since many face serious barriers to employment.

With HELP-Link, Montana might have found a middle ground.

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When Montana residents enroll in Medicaid, nonprofits like Opportunities Inc., which receives state funding, can offer career guidance and job training from professionals like Beisecker. An important part of that process is identifying barriers to employment – ​​such as a lack of education, child care or transportation – and finding ways to overcome them.

“There are ways to support work without taking away people’s health care,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families, which studies health care issues.

“Montana is the most concrete example of a connection between work and support,” she said. “That’s a place you need to look to make sure people are connected to job support and job training.”

Republican state Rep. Edward Buttrey of Montana, who created the HELP-Link program with Democratic state Rep. Mary Caffero in 2015, said it adheres to GOP principles.

“Republican governments generally want to make sure that if someone gets a benefit from taxpayers, they deserve it and in return they give a benefit back to the state and themselves,” Buttrey told Stateline. “I think this is what it’s all about.”

Caffero said that in reaching a compromise, lawmakers “put the people of Montana above partisan politics.”

“We created our own majority,” she said, “and the extremists were kind of on a shelf.”

Increasing interest

Medicaid is a program that provides health insurance to low-income people and is jointly administered by states and the U.S. government. Any state that wants to add a work requirement to Medicaid must ask the federal government for permission.

Grassroots groups are helping Medicaid recipients regain lost coverage

The Biden administration has repeatedly rejected states’ requests to impose work requirements. It also revoked approvals granted by its predecessor, which had signed thirteen of them. (Only one state, Arkansas, implemented its rule before courts stopped states from imposing it.) But with the election fast approaching, the prospect of a second Trump administration has led more Republican states to reconsider the idea .

That includes states like Arkansas, Idaho and Louisiana that chose to expand Medicaid to more people under the Affordable Care Act, better known as Obamacare. It also includes states still debating whether to expand Medicaid under Obamacare, including Kansas and Mississippi.

Georgia and South Carolina, neither of which expanded Medicaid under the ACA, have both sought federal permission to include work requirements in partial Medicaid expansions that are more limited than what is envisioned under Obamacare. Only Georgia, which is fighting the Biden administration in court, currently has a strict work rule for all its Medicaid enrollees.

How it works

Montana, which expanded Medicaid during the Obama administration, sought federal permission in 2019 to apply work requirements to the roughly 100,000 adults newly eligible for the program. Under the proposal, beneficiaries would have to work, find a job or volunteer at least 80 hours a month. There would have been exemptions for pregnancy, disabilities and mental illness.

However, in 2021, the Biden administration denied Montana’s request. Buttrey told Stateline that if former President Donald Trump wins in November, it’s likely Montana will try again. But whatever the outcome of the election, voluntary workforce training in HELP-Link has emerged as a possible compromise.

Beisecker said Opportunities Inc. has been working with the Help-Link program for about a year and a half. The nonprofit has been able to help people do things like obtain a commercial driver’s license, start a welding certification program, take medical coding classes and participate in construction training programs.

When people come in, we can meet them and say, “Hey, maybe you can take this training that we can help pay for, and you can come out and make $28 or $29 an hour.

– Jeff Beisecker, employment and training coordinator for Opportunities Inc., a Montana-based nonprofit

The nonprofit also has a community center that can help Medicaid recipients access vouchers for food, laundry facilities and other needs.

“We get referrals from other nonprofits we work with,” Beisecker says. “We have flyers that we send out so that people are aware of the program. We go to job fairs.”

More than 2,200 people have participated in the HELP-Link program since its inception, according to data from the Montana Department of Labor and Industry. Many have gone on to find jobs as nurses, dental hygienists, real estate agents, and computer programmers, among many other professions.

HELP-Link has built relationships with major local employers such as manufacturers and health care providers, said Heather O’Loughlin, executive director of the Montana Budget & Policy Center, a nonprofit that researches budget and tax issues. O’Loughlin said the decline in participation since 2021 is evidence that the program has moved many participants into stable jobs.

Caffero, the Democratic lawmaker, agreed.

“The program did exactly what we intended. People are getting jobs and jobs with benefits, jobs that pay a living wage, because they get education and training through HELP-Link,” she said. “That’s the goal. We don’t want the (Medicaid) rolls to go up.”

Buttrey noted that before the pandemic, Montanans stayed on Medicaid for less than two years on average. “We’ve given people some job skills,” he said. “We got them preventative care and help with addiction.”

Despite federal warnings, red and blue states are aggressively cutting Medicaid rolls

Robin Rudowitz, who oversees Medicaid research at KFF, a nonpartisan health research organization, praised Montana’s program for encouraging people to find jobs — and get off government assistance — without depriving them of health care while they do so .

She contrasted HELP-Link with the strict work requirements that Arkansas briefly imposed on Medicaid recipients during the Trump administration before a federal court struck them down. Those rules knocked about 18,000 people off the list. “Arkansas was really the only state that actually implemented the rules, to the point where individuals were deregistered for not following the rules,” she said.

Rudowitz and other health experts have also been critical of Georgia’s Pathways to Coverage program, launched last summer, which expanded Medicaid coverage to some low-income Georgians provided they worked or engaged in 80 hours a month would participate in another qualifying activity. Under that program, which is not considered a full expansion under Obamacare, 4,000 people have gained coverage, out of about 350,000 who would qualify based on their income.

Georgia’s Republican Governor Brian Kemp has defended the program and blamed the Biden administration for its slow start. The program expires next fall, but several months ago Georgia sued the federal government in an attempt to extend it.

“It’s fiscally foolish and anti-family,” Georgetown’s Alker said of the Georgia program. She noted that the state is leaving federal dollars on the table by avoiding a full-fledged expansion under Obamacare.

“It hasn’t been a path to coverage for anyone,” she said.