One of the biggest debates of the Montana Legislatures 69th session took center stage Wednesday afternoon, as lawmakers held hearings on three different proposals on how to address the upcoming expiration date for the states Medicaid expansion program.Montanas Medicaid expansion approved in 2015 and extended in 2019 is currently scheduled to sunset on June 30. During two overlapping committee hearings, legislators presented three bills each with a different possible way to move forward.Dozens of people were at the State Capitol Wednesday to make their voices heard on the proposals.I just want to say thank you to all the people who drove here to participate in this, said Rep. Ron Marshall, R-Hamilton, who chairs the House Human Services Committee. The House committee met for almost five hours Wednesday, hearing two bills that would remove the sunset date: House Bill 245, sponsored by Rep. Ed Buttrey, R-Great Falls, and House Bill 230, sponsored by Rep. Mary Caferro, D-Helena.During the hearing, no one spoke in opposition to either bill. Health care providers, mental health advocates, tribal members and business groups were among those who testified as proponents some of them speaking in favor of one bill, some supporting both, but all of them stressing that it was important to continue Medicaid expansion.When I used to talk to people that were struggling, they had to choose between care or work, said Matt Kuntz, executive director of NAMI Montana, a nonprofit that works with people with mental illness and their families. It's the hardest talks I have had to do in my life and I've talked to people who have had their kids killed, and all of these other things. That conversation, we had it week in, week out and we don't have it anymore, because of Medicaid expansion. There are significant differences between the two bills. HB 245 would make some changes in how the state connects people on Medicaid expansion with workforce development services, but it would otherwise essentially renew the program as it is now.We did something really special for the people of Montana in 2015, and again in 2019, Buttrey said. We created a system that, unlike in other states, actually moves people out of poverty and on to the road of success. Our system puts health care back in the doctor's offices and out of the emergency rooms. Our system has enhanced the pool of workers available to our businesses, and I'm happy to say we have ensured the future of our rural health care systems all of this while providing a positive savings to our general fund and the taxpayers of Montana.HB 230 would make a number of other changes. It would remove community engagement provisions that require people on Medicaid expansion to spend 80 hours a month on work, education, training or other approved activities requirements the state hasnt implemented because they didnt get a required waiver from the federal government. It would also allow people to remain covered under the program for a full 12 months even if their income or household size changes, and it would direct the state to open more public assistance offices where people could go to get in-person assistance with things like Medicaid applications.Caferro said the majority of people on Medicaid expansion are already working, so the community engagement requirements arent necessary. She said the other changes would help address the frustrations she heard from Montanans who lost health coverage during the states Medicaid eligibility redetermination in 2023 and 2024 and faced long wait times when trying to get their cases resolved.It makes government work for the people, she said. Dr. Jennifer Show, chief health officer for the Fort Belknap Indian Community, said allowing people to remain on Medicaid expansion continuously for 12 months would make a big difference for the people she works with.It increases continuity of care, she said. Patients cannot afford to have, suddenly, their meds stopped, inability to access a specialist because their redetermination was all of a sudden dropped.Fiscal analyses of HB 230 and HB 245 were not yet available during the hearing, but staff told lawmakers Caferros bill would require additional funding in order to staff the reopened public assistance offices. Shortly after the House committee began its hearing, the Senate Public Health, Welfare and Safety Committee started its own on a bill that would start winding Medicaid expansion down instead of extending it. Senate Bill 62, sponsored by Sen. Carl Glimm, R-Kila, would stop anyone new from applying for the program. Those already on Medicaid expansion would be allowed to stay on as long as they remained eligible, but if they lost eligibility, they would not be able to rejoin later.Glimm said the bill would create a soft unwind of Medicaid expansion and be more compassionate than a sudden end at the sunset date. He said the state could potentially be at financial risk if the federal government decides to reduce its support of Medicaid expansion, and that those leaving the program would have other options for health coverage including through the individual marketplace.I think that this is a financial choice that the state of Montana needs to make, and we need to look at the risks and the benefits, Glimm said.No proponents testified in favor of SB 62 Wednesday. However, Senate President Sen. Matt Regier, R-Kalispell, who has been skeptical of Medicaid expansion, told reporters this week that he supported the bill. Several of the same groups and individuals that testified in favor of Buttrey and Caferros bills also spoke in opposition to Glimms.In rural reservation communities, employment changes frequently, said Carole Lankford, a member of the Confederated Salish and Kootenai Tribal Council. When this employment becomes available, Medicaid coverage will be lost and then will not be available when the jobs disappear.Neither of the committees took immediate action on any of these bills on Wednesday.