Panel weighs presumptive Medicaid eligibility bill to speed home-based services for elderly

Senate Bill 72, presented to the House Appropriations Committee on Feb. 3, 2025, would establish a presumptive Medicaid eligibility process for older and physically disabled Montanans so they can receive home- and community-based services more quickly while the full Medicaid determination is completed.

Sponsor testimony described the proposal as a way to allow eligible individuals to begin receiving services within days of a need arising, such as after an unexpected hospitalization, instead of waiting weeks or months for a full Medicaid determination. The bill focuses on home- and community-based long-term services, excluding institutional nursing home redeterminations, and the fiscal note estimated initial costs for the program. The sponsor cited a fiscal note that included an estimated first-year state cost (state share) and said the number of people currently eligible and waiting supports the proposal.

Proponents—including the Montana Health Care Association, AARP Montana, Ability Montana, and Big Sky 55 Plus—testified that presumptive eligibility would reduce delays that often lead to higher-cost outcomes such as hospitalization or nursing-home placement. Rose Hughes of the Montana Health Care Association said the fiscal note did not capture likely savings from delaying or avoiding higher levels of care; AARP provided a comparison to national averages and argued Montana’s per-person estimates in the fiscal note may be high because of inclusion of some higher-cost populations.

Department of Public Health and Human Services (DPHHS) staff participated as informational witnesses. Jean Hermanson, Medicaid chief financial manager, said the department could not readily quantify potential savings in the fiscal note but acknowledged savings were possible in some scenarios. Hermanson explained that other states have implemented presumptive eligibility in various ways (State Plan amendments or 1115 waivers) and that where 1115 waivers are used CMS requires demonstration of budget neutrality.

Committee members asked technical questions about how the presumptive process would collect income and resource attestation, wait-list sizing, and potential coverage gaps if a full Medicaid determination takes longer than the presumptive period. Hermanson said presumptive forms would be self-attested and similar to other presumptive eligibility processes the department already uses for populations such as children and pregnancy; she agreed to provide the department’s presumptive eligibility form to the committee for review.

Representative Walsh asked about typical processing times; Hermanson said determinations generally take between 45 and 90 days and the fiscal note assumed a presumptive eligibility period of 45 days. Committee members also asked about the open referral waiting list; Hermanson said the “open referral” waiting list generally hovered around 130 individuals for services that were ready for Medicaid eligibility but waiting on determination.

Proponents emphasized that quicker access to services would likely reduce later, higher-cost institutional care; several witnesses gave back-of-envelope estimates showing potential savings if some people avoided nursing-home placement. The sponsor closed by urging support and highlighting that presumptive eligibility could improve access and reduce avoidable cost escalation for elders who otherwise wait for services.