Next week, Montana voters likely will say yes to expanding government-funded health insurance for as many as 30,000 uninsured kids in the state, at an ultimate cost of as much as $90 million a year.

Initiative 155, which expands Medicaid and the Children’s Health Insurance Program (CHIP) in Montana, has no organized opposition and is thought to have broad public support. Voters will decide I-155 in next Tuesday’s general election.

Yet while I-155 is expected to gain approval, it still has some hurdles to clear before it’s fully enacted. And, even if all goes according to plan, the coverage probably still won’t reach the entire 30,000 kids until 2011 or 2012.

“I would hope we could reach (the 30,000 additional kids covered) within two or three years,” says state Auditor John Morrison, the state insurance commissioner, who has spearheaded the campaign for I-155.

Morrison says the critical piece of the I-155 puzzle will be how the state develops an enrollment plan, which is supposed to be an aggressive push to find and sign up eligible kids for health insurance.

“There is a substantial amount of work to be done to implement the enrollment provisions of the plan,” he says. “That’s by far the biggest contingency.”

The enrollment plan is expected to involve schools, health care providers, local governments, tribal governments and others who have contact with families that may be eligible for the programs.

Funding for the expansion also must be approved by the 2009 Montana Legislature. I-155 puts the expansion into state law, but ballot measures cannot appropriate money.

Republicans, some of whom have resisted expanding CHIP and Medicaid, might control one or both of the houses of the next Legislature.

Morrison, a Democrat, says there is plenty of Republican support for

I-155, and that he believes “all reasonable Republicans will respect the will of the voters,” and support funding for the measure if its passes by a wide margin next Tuesday.

I-155 would expand health coverage for Montana children by making more kids eligible for CHIP and Medicaid, which are state-federal programs that provide health insurance for low- and moderate-income families.

Under I-155, children would be covered by Medicaid if their family earns up to 185 percent of the federal poverty level, or $32,560 a year for a family of three. The income ceiling for CHIP eligibility would increase to 250 percent of the federal poverty level, or $44,000 a year for a family of three.

The current income ceiling for CHIP in Montana is 175 percent of the federal poverty level, and about 17,000 kids are covered under the program now. Medicaid currently is available only to kids whose families are at 100 percent of the poverty level for ages 6 to 18 and 133 percent for younger children.

If I-155 is approved, kids currently on CHIP would move to the Medicaid program and the money spent on CHIP would start covering kids above the 185 percent threshold.

Mary Dalton, head of the state Health Resources Division, says the state’s Medicaid plan will have to be amended, which could take four to six months once the funding is approved by the 2009 Legislature.

New rules also would be needed to implement the CHIP expansion, including the I-155 provision that says eligible families that already have health insurance for the adults can use CHIP money to add their children.

“That will be a pretty extensive rule,” Dalton said. “My guess is that we’ll have a work group that will help us.”

Still, Dalton says the state should have most of the expansion ready to go and enrolling new children by its Oct. 1 starting date next year.

Morrison says he expects “thousands and thousands” of children will be signed up for coverage within the first year.

I-155 also is contingent on the approval by Congress of federal funding for both CHIP and Medicaid. The federal government funds about 77 percent of CHIP and two-thirds of Medicaid, which is an “entitlement” program whose funding is all but certain. CHIP funding is authorized only through March.

Democrats will be in control of Congress next year and are expected to extend and possibly expand CHIP, leaving the final word up to the next president. Democratic presidential candidate Barack Obama voted for a CHIP expansion as a U.S. senator last year, before it was vetoed by President Bush; Republican candidate Sen. John McCain voted against it.

The Schweitzer administration estimates I-155 would cost the state an additional $22 million a year when fully implemented. It’s also estimated to bring in an additional $70 million of federal funding, to match the Medicaid and CHIP spending. Schweitzer, a Democrat up for re-election, has said he plans to reserve money for I-155 in his proposed state budget for next year.

While I-155 has no organized opposition, some Republican state legislators are speaking out against it, saying it’s too costly and a step toward “socialized medicine.”

“We’re expending money for people who make more dollars than those who are really low-income,” says Rep. John Sinrud, R-Bozeman. “You’re going to end up putting more and more money into it, because people are so dependent on it. It’s just a total incrementalism (toward) socialized medicine.”

Morrison says society already guarantees a public education for all children, and that it’s time for Montana to do the same for children’s access to health care. “We have a moral duty in this society so that every child reaches adulthood with a sound mind and a sound body,” he says. “Everybody has a stake.”