Montanans are losing insurance through the state’s exchange faster than expected, and at least some lawmakers are concerned that people who are eligible for coverage don’t have it.
Sen. Christopher Pope, D-Bozeman, called the situation a “four-alarm fire” that started in January and hasn’t let up.
But the head of the Department of Public Health and Human Services said he believed the disenrollments were largely accurate.
Nearly 19,000 people who were expected to be covered by Medicaid weren’t as of September, according to a report Wednesday to a legislative budget committee.
The total reflects 5.4% fewer traditional Medicaid members and 9.6% fewer expansion members than were projected to have coverage as of September, according to the report from the Department of Public Health and Human Services.
In April, Montana began Medicaid redeterminations after a freeze during the COVID-19 outbreak, when the federal government allowed people to keep coverage without proving eligibility.
Since then, 104,097 people have lost coverage, and the process of determining whether people should have coverage has been plagued by difficulties in Montana.
On Wednesday, DPHHS reported improvements in some of the earlier problems, such as a reduction in long wait times on the phone.
As of this month, DPHHS said the redetermination process had begun for more than 90% of people covered by Medicaid.
But some Democratic lawmakers said the situation is an emergency, puts Montana in a bad light compared to other states and has a negative impact on people’s health.
Pope and Rep. Mary Caferro, D-Helena, both asked DPHHS if it would consider pausing the redetermination process or extending the window to complete it in order to get eligible Monanans enrolled.
An estimated 72,000 people lost coverage for procedural reasons, not because the department found them ineligible, Caferro said, citing data from the Centers for Medicare and Medicaid Services.
Federal data also show that an estimated 41,513 applications are still being processed and 40% of renewals are pending, above the national average of 22%. About 40% of renewals are still pending.
But DPHHS director Charlie Brereton said he would not stop the process. He said that because of the way the re-enrolment process works, the department won’t know until late April or early May whether people who qualify for Medicaid won’t be covered.
But Brereton also said he believes the numbers reflect the state of Montana’s economy, with low unemployment rates and wage increases that he said are keeping up with inflation. And he said people have another chance to enroll if they didn’t submit paperwork the first time.
“I’m confident in our redetermination process,” Brereton said. “I believe that many of the Medicaid members who were disenrolled were disenrolled correctly.”
As of April, an estimated 330,000 people were enrolled in Medicaid. According to a report to the Legislature’s interim committee on health and human services, 149,900 people were enrolled in traditional Medicaid and 96,659 in expansion as of September 2023.
Pope asked if current numbers were available as opposed to enrolment numbers from September, 90 days ago, and Brereton said they were not. But Brereton said that if someone who lost coverage provided the necessary paperwork within a 90-day window, they would be covered retroactively.
Pope praised the retroactive payments: “I think it’s a really positive thing.”
But Pope also said it’s important to get eligible people covered, and while some systems are improving, his constituents are concerned about Montana’s inability to get people enrolled compared to other states.
And Caferro said Montanans are experiencing negative health effects as a result of the delay: “There are Montanans who are being denied health care because they don’t have coverage as identified in the system.”
She said she’s heard of children whose health has deteriorated to the point where they need surgery. She said the parents are doing the best they can, but the lack of health care is causing problems.
She also said Montanans lose coverage at a rate that’s higher than the national average, 35% compared to 26%, and the renewal rate here is lower, 25% compared to 51%, citing federal data.
Caferro said she also wants to know how DPHHS is reaching out to special populations, such as people with Alzheimer’s disease or those in nursing homes and assisted living facilities. She said the gap has a negative impact on the business model of providers.
“These are serious issues and people are suffering,” Caferro said.
Although Brereton said he would not pause redetermination, he said DPHHS has been working in an “efficient but quality manner”. He said the agency is doing outreach to organisations, and it’s also targeting some cases that are more complex.
Previously, CMS said Montana’s hold times for phone calls were too long – an average of 42 minutes – and Brereton said Medicaid-only calls have an average hold time of less than five minutes.
He said wait times for call centre lines dropped 13% from September to October, and “abandonment rates”, or hanging up before being connected, dropped 23% over the same period.
In addition, procedural abandonments fell from 36% to 25% between May and November, Brereton said. And he said “ex parte” renewal rates, or automatic renewals, are increasing, from 21% to 33% over the same period.
“The state of Montana had the opportunity to move even faster, and we chose not to,” Brereton said.
