Republican leaders’ banishment of a transgender lawmaker from floor debates in the recently ended Montana legislative session seized the nation’s attention. It also overshadowed significant health policy changes and historic levels of health care spending.
The session likely will be remembered for GOP leaders , one of two transgender representatives in the Capitol, from House floor debates. That the ban has distracted from approvals of unprecedented increases in Medicaid mental health and provider reimbursement rates is unfortunate, said Mary Windecker, executive director of the Behavioral Health Alliance of Montana.
鈥淲e鈥檝e never talked about these kinds of numbers before,鈥 Windecker said.
Lawmakers also passed major bills related to abortion, behavioral health, transgender rights, workforce issues, and insurance requirements. Some, like the Medicaid reimbursement hikes, were greeted with cheers. Others, with threats of legal challenges.
Medicaid Reimbursement
Windecker said several factors provided momentum for Medicaid provider rate increases, including the covid-19 pandemic and pressure from providers and facilities after the legislature cut rates to the bone in 2017 amid a budget shortfall.
Back then, lawmakers cut nearly $50 million from the Department of Public Health and Human Services budget, a devastating blow for providers, with long-term ramifications. Last year, 11 nursing homes in Montana closed their doors, citing low provider rates as a chief cause.
By contrast, lawmakers went into this session with a $2.5 billion surplus in the state budget, which lawmakers and providers said should be used to rebuild the state’s health care system.
The legislature commissioned after the last session to look at Medicaid provider reimbursement rates in areas like behavioral health, long-term care, and developmental disability services. Throughout the session, lawmakers heard hours of testimony from providers and patients asking lawmakers to fully fund the provider rates the study identified as covering the average cost of services.
During the last discussion on the state budget, on May 2, Republican Rep. Llew Jones 鈥 chair of the House Appropriations Committee 鈥 lauded the two-year budget for exceeding the 100% benchmark for provider rates.
Democratic Rep. Mary Caferro made a distinction between the next two fiscal years. She said the funding falls short of the benchmark in the first year of the budget 鈥 by about $10 million.
鈥淏ut you know what, it鈥檚 nothing to shake a stick at,鈥 Caferro said. 鈥淚鈥檓 very, very happy that we got this far.鈥
Still, it will be important to watch how the boosted provider rates help the supply of services, what that means for caseloads, and whether the health department can start getting people off waitlists, said Montana Budget and Policy Center Executive Director Heather O鈥橪oughlin.
According to Rose Hughes, executive director of the Montana Health Care Association, which advocates for nursing homes, the provider rates for nursing homes increased from $209 per patient per day to $262 the first year of the next biennium, and $278.75 the next.
鈥淭hey鈥檝e done a lot and the problem is that the challenges are also huge, and the workforce issues are huge, and it鈥檚 going to take time to see,鈥 Hughes said. 鈥淚 hope it works. I hope what they鈥檝e done works.鈥
Abortion
Lawmakers passed 10 bills restricting abortion, five of which Republican Gov. Greg Gianforte signed in a ceremony on May 3.
Since the Supreme Court overturned Roe v. Wade in June 2022, Montana has been one of 20 states and the District of Columbia to . Abortion access is protected through the of the state鈥檚 constitution. Bills championed by the Republican supermajority chipped away at that protection and are expected to be challenged in court.
Among the new laws, takes the right to an abortion out of the constitutional privacy clause in an attempt to remove the legal justification for allowing continued abortion access. At the bill signing, Gianforte said this was one of the most important bills of the session.
is a version of a ballot measure, called the 鈥渂orn alive鈥 referendum, that Montanans. HB 625 requires health care providers to give care to an infant born alive after an attempted abortion or face a fine and up to five years in prison.
, by the state health department, requires prior authorization and additional documentation for abortions to be covered by Medicaid or the Children鈥檚 Health Insurance Program. The health department adopted an administrative rule that would have the same effect, but a state judge amid a legal challenge.
prohibits the abortion of a 鈥渧iable鈥 fetus. Viability in the bill is presumed at 24 weeks and defined as the ability of a fetus to live outside the womb, including with artificial aid.
Another dilation and evacuation procedures, one of the most common ways of ending a pregnancy after 15 weeks.
Transgender Rights
, which prohibits certain surgical and medical treatments for youth with gender dysphoria, is the bill that sparked Zephyr to tell lawmakers that if they voted for it, and Gianforte鈥檚 amendments to it, they would have 鈥渂lood on [their] hands,鈥 referring to elevated among trans youth.
Gianforte signed SB 99 into law, as well as , which allows a student to call another student by a name or refer to them with pronouns they don鈥檛 use without legal disciplinary action. Opponents refer to it as a 鈥渄eadnaming鈥 bill.
Lawmakers also passed a and restricting where they can be held that was ultimately amended to replace 鈥渄rag鈥 with the descriptor 鈥渁dult-oriented.鈥 Another bill headed to Gianforte鈥檚 desk in a way that opponents say erases transgender, nonbinary, and two-spirit people from Montana code. The sponsor, Republican Sen. Carl Glimm, said the point is to distinguish sex from gender. That bill was to be transmitted to the governor.
Behavioral Health Investment
Gianforte and lawmakers from both parties started the session promising investment in behavioral health, including building community-based services and upgrading the beleaguered Montana State Hospital, which the governor outlined as .
Republican Rep. Jennifer Carlson鈥檚 , which would stop involuntary commitment of most patients with Alzheimer鈥檚, traumatic brain injuries, or dementia to the Montana State Hospital, is awaiting a decision from the governor.
Gianforte also announced a $2.1 million grant to fund free, optional mental health and substance abuse screenings for schools statewide. The grant will also support same-day services for students assessed as being at high risk for suicide.
Another bill, which passed in the final hours of the session, would create a for behavioral health and set up a commission to oversee the funding allocation.
There was also some tug of war over Gianforte鈥檚 Healing and Ending Addiction through Recovery and Treatment, or , fund.
, sponsored by Caferro, makes it so youth suicide prevention programs can benefit from HEART funds. Carlson sponsored , which requires reporting on how HEART money is used. Both bills passed by wide margins and were signed into law.
Access and Workforce
Another one of the lawmakers鈥 goals at the beginning of the session was expanding patient access to health care.
The governor signed into law, allowing physician assistants to practice independently. Gianforte said in a statement that it will reduce patients鈥 barriers to health care, particularly in rural areas.
, also signed by the governor, expands pharmacists’ ability to prescribe certain drugs and devices that do not require a new diagnosis or are 鈥渕inor and generally self-limiting.鈥
Lawmakers passed , which would allow behavioral health providers licensed in another state to practice in Montana.
Insurance Requirements
A handful of new insurance requirements are also on track to become law.
One bill waiting on the governor鈥檚 signature would copayments at $35 for a month’s supply.
Another diabetes-related bill would require coverage of 20 visits of in the first year of a patient鈥檚 diagnosis and 12 subsequent follow-ups. Meanwhile, a bill that would have of continuous glucose monitors died in the Senate.
Two bills signed by the governor and to be covered by insurance.
that would require insurance to cover 12 months of birth control is awaiting transmittal to the governor鈥檚 office, as is one that would require insurance coverage of fertility preservation for cancer patients.
Keely Larson is the 麻豆女优 Health News fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and 麻豆女优 Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.
