Montana begins process of ‘redetermining’ Medicaid eligibility for residents

Nearly 7,900 Montanans may lose Medicaid coverage by the end of the month.

For comparison purposes, that’s roughly the number of people who live in Whitefish. And, even though the process, plans and communication have been anticipated, the state is beginning its initial round of “redetermination” for the federal medical insurance program administered through the state.

Two factors are driving these numbers – a change in the law that stretches back to 2021 and the end of COVID-19 pandemic rules, which combined to keep Montanans who qualified for Medicaid on the program’s rolls, insured.

Until April.

Montana had, until the 2021 legislature changed the rules, been one of two states that had “continuous eligibility.” This means that an individual who qualified for Medicaid received the coverage for one continuous 12-month period, even if they had a change in income or status that may have otherwise resulted in a loss of coverage. Lawmakers in the Republican majority argued that the change was necessary to ensure the insurance coverage went only to those who qualify, and they would exit it as soon as their life circumstances change. The change, they said, would save taxpayer money.

Meanwhile, Democrats argued that residents who are on the program have fluctuating life circumstances and ending the policy would create a lot “churn” and result in a rise in uncompensated care for healthcare systems.

But the law that was scheduled to take effect in 2021 was halted by pandemic measures that required continuous eligibility. The end of pandemic measures recently, though, has allowed the change to take effect, and Medicaid recipients who aren’t aware of the changes may not understand that they have to complete the paperwork and go through the “redetermination” process to qualify.

As of Thursday, 43% of the 18,370, or approximately 7,900 residents, may fall off the Medicaid rolls.

Health leaders with the state and other organizations believe some of the decrease will be natural – the pandemic has ended and the qualifications have reset. However, others are worried that with the change, some may lose coverage because they’re not aware of it.

And the numbers for April are similar, if not even lower, than the number of cases in the upcoming months. For example, May has 21,000 cases that will be redetermined and August has 23,000 cases.

“This is a marathon, not a sprint,” said Olivia Riutta, director of special populations for Cover Montana, the third-party navigator organization that helps residents through the qualification process for Medicaid as well as other insurance options through the marketplace. “We do this phone call by phone call, one by one. I look at that number and think that people just need more information.”

The good news for those who have gotten the notification for April’s batch but haven’t returned them is that they have until the end of May on Wednesday to do so.

Riutta said those who miss it may have a chance to ask for retroactive eligibility if they qualify so there’s no gap in coverage.

For her organization and the state, the new challenge – in addition to the redetermination process itself – is to let those on Medicaid know.

Jon Ebelt, spokesman for the Montana Department of Public Health and Human Services, said for the past couple of months the department has been working on outreach, especially urging residents to update their contact information and address.

“As part of the campaign to update contact information, DPHHS has sent approximately 73,000 text messages to households most likely to have new mailing addresses, encouraging them to update their contact information,” he said.

In addition to that, the department has also sent information to Medicaid recipients telling them about the changes and walking them through the steps.

Riutta said it’s essential for residents to respond to any changes and paperwork the state sends.

For those who no longer qualify for Medicaid, she said they’re helping residents work through the marketplace to find the best plan.

She said it’s too early to know how the coverage will look for Montanans during the new process, especially with the pandemic changes ending. However, she said all eyes are watching the uncompensated or “charity care” that hospitals provide to see if the numbers start rising, which would suggest that people who may qualify for coverage have lost it.

She said so far, the call volume to her office, where navigators are on hand to help, has risen noticeably.

“We’re having very high call volume, and we have seen a sharp uptick in renewals and need assistance,” she said.

That’s a good thing: People are calling, Riutta said. What she doesn’t know is how many aren’t calling or don’t know about the changes.

It will take even longer to figure out the effects of churn on the system, which covers several aspects. For example, residents coming off and on the rolls may create more paperwork for the state, driving up administrative costs. It may also mean more uncompensated care for health organizations. And churn may mean that residents do not take more preventative health measures because they’re uncertain whether they’re covered.

However, both Riutta and Ebelt said that’s something that may take up to a year in order to begin getting reliable statewide data.

Ebelt said the department is using a “population-based” approach that prioritizes individuals who had changes “that would have likely impacted eligibility during the continuous enrollment period, but remained enrolled during the public health emergency.”

Populations that include the “aged, blind and disabled” won’t begin until the fourth month, which would be July.