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Medicaid unwind hits older Montanans hard

by Terry Minow
| February 28, 2024 12:00 AM

Over 120,000 Montanans lost their Medicaid and Healthy Montana Kids health care coverage in the past few months. Shockingly, 70 percent of those terminations were due to administrative reasons: failures on the part of the Gianforte administration. 

The administration’s poorly thought-out, under-staffed Medicaid redetermination process has hurt thousands of Montanans, especially our elders and children. 

During the pandemic, in the interest of keeping as many people insured as possible, the federal government suspended the requirement to check individual’s eligibility for Medicaid. Now that the emergency is over, states are again required to check the eligibility of people on Medicaid and Healthy Montana Kids, a process called Medicaid redetermination. 

Sadly, Montana has one of the worst records in the country for cutting coverage for likely qualified people during the redetermination process. Advocates and elected officials begged the Gianforte administration to slow down on the redetermination process. The administration ignored these warnings and spurned tools and support available to the state from the federal Center for Medicaid and Medicare Services. As a result, thousands of qualified Montanans lost their health care coverage for no good reason. 

Due to this catastrophe, 18 Montana nursing homes and assisted living facilities reported through the Montana Healthcare Association that: 

●  154 nursing home residents have been cut off from Medicaid and are in the arduous process of reapplying. 

●  Staff trying to help residents reapply wait on hold for an average of 3-6 hours. 

●  It takes months to get a caseworker assigned to a Medicaid application. 

●  Delayed payments to these 18 facilities because of redeterminations and pending applications total $2.3 million. 

Similar stories are coming from group homes and agencies that provide services for adults with developmental disabilities, and from substance abuse residential treatment facilities. 

Most older adults in Medicaid beds have worked their entire lives, contributed to their communities, and raised their families here in Montana. They have already exhausted their life’s savings and assets paying for care. They are unable to navigate the administrative maze required to keep their Medicaid health care coverage. Some of them are veterans. 

Adding insult to injury, when caregivers or loved ones who are providing care for these folks try to help get them reinstated on their insurance, they are met with bureaucratic roadblocks. After helping residents track down their most recent Social Security statement or last 6 months of bank statements, some caregivers find out that because they didn’t schedule an appointment, the resident has already been denied coverage. 

Senior long-term caregiving facilities were already reeling from dramatic, persistent shortfalls in state reimbursement rates that eroded their staffing, their capacity and their reserves. Montana lost more than 10 percent of its nursing homes in 2022. The loss of insurance for clearly qualified patients in nursing home beds is now costing these same care providers millions of dollars at a time when they have no cushion left. The state’s heedless push to block qualified individuals from retaining their insurance could trigger even more closures in assisted living and skilled nursing home care. This will affect not just Medicaid patients, but others who need skilled nursing facility care to recover from an injury or surgery. 

The effects on elderly Montanans are just one example of how this process has harmed our people and our economy. What happens to children who can’t get immunizations and well-child appointments? Or parents who face medical debt for the care they and their children need? How about people who have lost their mental health counselors and access to needed medications? Montana already has a crisis in mental health care. This will surely make matters worse. 

Along with the human cost is the major cost to our economy. Three quarters of the funding for Medicaid is provided by the federal government. Due to this loss 

of eligibility, Montana stands to lose millions of federal health care dollars that support our rural hospitals, local pharmacies, nursing homes and treatment 

centers. If these places are forced to close or cut services, it will affect thousands of Montanans. 

Governor Gianforte ignored many warnings and proceeded with a botched Medicaid redetermination process that has hurt untold numbers of Montanans, especially our elders and children. 

Governor, you are the only one who can step forward and fix this disaster. Please do so. 

Terry Minow is chair of Big Sky 55+, a group that engages Montanans 55 and older to advocate for forward thinking policies such as health care and economic security for all. She is a fourth generation Montanan who ranches in the Boulder Valley south of Helena.

Terry Minow is board chair of Big Sky 55+.