Redetermination challenges spur Medicaid coverage losses in Montana

Thousands of Montanans may have lost public health insurance coverage due to a difficult Medicaid redetermination procedure rather than as a result of being ineligible, according to new government data.

The Department of Public Health & Human Services released statistics showing that nearly 93,000 Montanans have been disenrolled from Medicaid since the state began reevaluating eligibility in April.

Of that figure, 27,727 or around 30% were found to be ineligible. The vast majority of closures, however, were due to “failure to provide requested information.” About 60,000 Montanans have lost their coverage for this reason; this accounts for around 64% of the impacted individuals.

Under the current process, the DPHHS contacts individuals whose coverage is up for renewal by mailing them a packet. The individual must then complete the packet and return it for review.

If the DPHHS does not receive a completed packet from the individual, then Medicaid coverage is terminated. The department said this is a 60-day cycle.

However, several organizations have expressed concern about the effectiveness of this process as well as the healthcare coverage gaps residents experience in the interim.

The Centers for Medicare & Medicaid Services said it is closely tracking renewals in all states, including Montana, and working with states to address issues.

“CMS continues to urge states to adopt the strategies put forward by CMS to help make renewals easier for individuals,” a spokesperson said. “CMS’ top priority remains ensuring access to quality, affordable health coverage, including through Medicaid, CHIP, the Health Insurance Marketplaces, Medicare or an employer.”

Nationwide redetermination

Montana’s redetermination process coincided with the Biden administration putting an end to public health emergency measures introduced during the COVID-19 pandemic.

Montana Gov. Greg Gianforte was among a group of GOP governors who had been urging President Biden to end the public health emergency as early as December 2022. Their main concern was the financial impact on states due to increased enrollment in Medicaid.

States like Montana that are reevaluating enrollment eligibility hope to decrease Medicaid spending in their budgets now that the public health emergency has ended.

A study by the Montana Healthcare Foundation found that Medicaid spending increased as a result of the increased enrollment. However, it also noted that a significant portion of those costs were reimbursed by the federal government.

In 2021, around 278,000 Montanans were enrolled in Medicaid. By April 2023, that figure had increased to over 320,565.

As of July 2023, DPHHS data shows that 292,179 people were enrolled. That figure may have decreased as redetermination closures continued in August. However, the latest enrollment figures have not been confirmed by the health department as yet.

Renewal process complaints

The Medicaid redetermination or unwinding process in Montana has faced heavy criticism from residents and groups including the Montana Democratic Party.

Local media has reported widely on issues like packets being sent to the wrong address, residents being unable to reach the department and similar challenges.

“Families who have lost coverage describe chaos and confusion with long call wait times as they attempt to reach DPHHS and contradictory letters arriving in the mail days apart,” the MDP said in a recent statement.

The group claimed that one resident’s family “never received a notice they were dropped or given a chance to appeal”.

In June, as the severity of the issue became apparent, U.S. Department of Health and Human Services Secretary Xavier Becerra expressed concern about families losing coverage “due solely to administrative processes.”

He cautioned state governors to streamline the redetermination process to avoid this from happening.

Long call center wait times was one of the issues the CMS stepped in to address in August. At the time, it sent a letter to DPHHS directly, urging the process to be improved.

No plans for the process to change

The DPHHS did not respond to inquiries about the current redetermination process. However, a notice on its website maintains that the department has several lines of communication open with residents.

It said that after mailed packets are sent out, the department also sends out reminders via mail and text. It also mails out a final letter “at least 10 days prior to loss of coverage.”

In earlier communications, DPHHS representatives indicated that the department was considering a public information campaign to address confusion about how the process works.

Another representative said the department was expecting the first four months to be the most challenging part of the process, and the one that would see the most people unenrolled. According to DPHHS data, no one was removed from Medicaid coverage as part of redetermination in September.

Between April and September, 42,625 residents successfully submitted their information for reevaluation. More than 70,400 people also had their coverage renewed.

Rayne Morgan is a Content Marketing Manager with PolicyAdvisor.com and a freelance journalist and copywriter.

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Rayne Morgan is a journalist, copywriter, and editor with over 10 years' combined experience in digital content and print media. You can reach her at [email protected].