News

Actions

Medicaid redetermination process criticized in Montana

Posted
and last updated

HELENA — Since the start of a ten-month eligibility redetermination period, Montana regulators report more than 130,000 people have been removed from the state Medicaid program.

Montana Democrats have criticized the Gianforte administration’s handling of the redetermination process. On Tuesday, they held an event at the Montana State Capitol to highlight stories from health care providers and patients, who said there have been real impacts for people who’ve lost Medicaid coverage.

“I think it's incredibly important to put names and faces with this reality,” said Senate Minority Leader Sen. Pat Flowers, D-Belgrade. “These aren't just numbers. These are real people. These are our friends, neighbors, family members that are out there suffering as a result of this mismanagement.”

Among those speaking Tuesday was Kristin Melli, a nurse practitioner in Kalispell, who works with children there and in eastern Montana tribal communities.

“I've had a number of kids who their parents have shown up to the pharmacy to pick up their medications, only to be told that their coverage has been terminated without them knowing,” she said. “I’m not sure exactly where the miss is on that.”

Kristin Melli

Melli told stories about two families she worked with who she said were in the midst of seeking care when they discovered they’d been disenrolled from Medicaid and struggled to get through the process of reapplying. She said she’s also concerned about patients who aren’t seeking care after their families find out they’ve lost coverage.

“From my perspective, when we're already working so hard to ensure that kids have everything they need at the moment that they need it, I just wish that they could stay on their health insurance and not have these gaps in their care,” she said.

Every state has had to go through a redetermination process. States used to have to regularly recheck Medicaid rolls to make sure people were still eligible, but during the COVID public health emergency, federal authorities declared everyone on a state Medicaid program could remain enrolled. That requirement ended Apr. 1, 2023.

Data from the Montana Department of Public Health and Human Services shows, as of March 21, 132,697 people had lost Medicaid coverage since the redetermination began last year. According to data DPHHS released to lawmakers last month, that includes 35,798 children.

On Tuesday, Flowers; House Minority Leader Rep. Kim Abbott, D-Helena; and Democratic gubernatorial candidate Ryan Busse and his running mate Raph Graybill said they had heard numerous reports about people trying to appeal their termination or reapply for Medicaid and facing long wait times on call centers or having to go to Offices of Public Assistance in person.

“The only reason there’s not 500 people standing up here is because these are working people – they can’t take time off,” Busse said.

Abbott said they believe many of the people who lost coverage should have remained eligible, but that there’s not clear data about that because around two-thirds of the terminations were “procedural” – meaning the person didn’t provide DPHHS with requested information, rather than DPHHS declaring them ineligible.

During an interim legislative committee meeting last month, DPHHS Director Charlie Brereton said the department was working to clear its backlog of redetermination cases. He said they’ve reduced the number of procedural disenrollments from month to month.

In a statement to MTN, a spokesperson for Gov. Greg Gianforte’s office said the event showed “far-left activists are recycling their tired talking points, and want to overburden the system by keeping folks who are ineligible on the rolls and having Montana taxpayers foot the bill.”

“Redetermination is working as intended: people who are ineligible for Medicaid are no longer on it,” they said.

Gianforte’s office said Montana’s Medicaid enrollment in December 2023 was nearly at the same level as it was in March 2020 before the public health emergency. They said the redetermination process would ensure that people who shouldn’t be eligible for the program aren’t weighing down a safety net for the most vulnerable people who need it.

DPHHS also released a statement from Brereton.

“DPHHS remains focused on finishing this common sense, federally directed process that ensures only eligible individuals are receiving taxpayer-funded Medicaid coverage,” he said. “Our time and energy will continue to be dedicated to the clients we are privileged to serve – not to more political theater and exhausted talking points.”

DPHHS data shows more than 41,000 individuals’ redeterminations were still being processed, as of March 21.