Subcommittee hears biennial Medicaid report, warns FMAP drop will shift tens of millions to state

The Montana Department of Public Health and Human Services (DPHHS) and the Legislative Fiscal Division (LFD) on Monday presented the biennial Medicaid in Montana report and new expenditure projections to the Section B Appropriations Subcommittee, laying out enrollment, spending and a projected decline in the federal medical assistance percentage that will raise state costs.

DPHHS Executive Director Rebecca DeCamara opened with the program’s data baseline. “My name is Rebecca DeCamara and I am the executive director for the Medicaid and Health Services Management practice,” she told the subcommittee, and she emphasized that much of the report’s data are drawn from state fiscal year 2023 claims because providers have up to 365 days to bill.

The report shows state fiscal year 2023 average monthly Medicaid enrollment at about 289,413 people — roughly 168,000 on traditional Medicaid and about 121,410 covered through expansion. Total FY2023 benefit expenditures exceeded $2.3 billion; DPHHS reported the state share was roughly $501 million (about 21 percent) with the federal share near $1.9 billion (about 79 percent). DeCamara and other presenters repeatedly cautioned that FY2023 figures are unusually high because the data window spans the COVID-era enrollment pause and later redetermination activity.

Why it matters: the federal matching rate that determines how much of those dollars come from Washington has been falling as Montana’s per‑capita income rises. LFD and DPHHS said a lower FMAP would reallocate tens of millions of dollars of Medicaid costs from federal to state funds in the coming biennium.

DPHHS staf…