Committee hears fiscal case for 3-year continuous Medicaid eligibility for children under 6

The House Appropriations Committee met to consider House Bill 185, a bill to provide three years of continuous eligibility for children under age 6 in the Healthy Montana Kids Plan, the sponsor said.

Representative Ed Staffman, House District 59 of Bozeman, told the committee the change is intended to reduce administrative churn and keep children enrolled in preventative care. “A child enrolls, stays enrolled, even if the parents shift around in jobs but without substantial income changes,” Staffman said, adding that administrative churn forces reenrollments that are costly and interrupt care.

The bill would replace the current 12‑month redetermination cycle for eligible children with a three‑year period before states require a reenrollment. Staffman and several proponents pointed to experience from other states and to studies indicating administrative and downstream savings from maintaining continuous coverage.

Gene Hermanson, Medicaid chief financial manager at the Department of Public Health (as identified in the hearing), described the fiscal assumptions the department used for its fiscal note. The department assumed an 11% increase in member months for Medicaid and CHIP among the affected age group, and estimated administrative savings of about 1,880 staff hours from fewer redeterminations. Hermanson said those hours are likely to be reassigned to other eligibility work across programs rather than eliminated as a position reduction.

Witnesses and informational presenters emphasized potential savings from avoided emergency visits and better-managed chronic conditions. Stephanie Jerram, director of the Office of Health Policy at the Oregon Health Authority, described Oregon’s experience under a Section 1115 Medicaid demonstration waiver that preserves eligibility until age 6 and said Oregon has not seen “meaningful” cost increases two years after implementation. Dr. Lauren Wilson, advocacy chair and immediate past president of the Montana chapter of the American Academy of Pediatrics, cited studies estimating administrative churn costs and contrasted those with the lower cost of preventive care for conditions such as asthma.

Several proponents from Montana nonprofit and advocacy organizations urged the committee to weigh long‑term benefits: Jasmine Krotkov (Truth to Power) and Matt Kuntz (NAMI Montana) said continuous eligibility would reduce paperwork burdens on families and could yield broader social and economic benefits.

Committee members asked technical and budgetary questions about how eligibility is determined, how the department would demonstrate budget neutrality to CMS under a Section 1115 waiver, and whether CHIP funding caps could require waiting lists. Hermanson said CHIP has a federal funding cap and the department added a technical note in the fiscal materials to flag the theoretical possibility of a CHIP wait list, though he said the department’s projections do not anticipate that outcome.

Sponsor closing remarks reiterated that multiple states — including Oregon — have obtained federal approval for continuous eligibility under waivers and that CMS has encouraged states to pursue such demonstrations. Representative Staffman repeated the sponsor’s estimate that the fiscal note equates to roughly 37,000 additional member months (about 3,100 child‑equivalents), with a distribution the fiscal note lists as approximately 2,200 Medicaid, 324 CHIP and 572 tribal months.

No committee vote was taken during the hearing. The hearing record includes agency staff available for questions and a series of proponent witnesses and informational presenters.