Feds urge more measures to keep kids on Medicaid

The federal government is calling on Montana to take additional measures to stop kids from losing health insurance coverage.

According to data from the federal government, Montana has seen the fourth-largest percentage drop in children enrolled in Medicaid and the Children’s Health Insurance Program, or CHIP, since the start of a nationwide process to redetermine the eligibility of everyone enrolled in the program.

From March to September, children’s Medicaid and CHIP enrollment in Montana dropped by 24,175 children, or 18 percent of those previously covered, according to the Centers for Medicare and Medicaid.

That change triggered a letter Monday from the federal Secretary of Health and Human Services Xavier Becerra saying he was “deeply alarmed.” 

In a statement Monday, a spokesperson for Gov. Greg Gianforte said "the governor is committed to ensuring Montana children who are eligible for Medicaid coverage have it, and has confidence in the Montana Department of Public Health and Human Services as it exercises its authority, as approved by the Biden administration, to verify the eligibility of Medicaid recipients."

Earlier this year marked the start of a massive process called redetermination to evaluate if those covered by Medicaid still qualify for the program. When the federal government terminated the public health emergency tied to COVID-19, it triggered the end of a requirement that people who qualified for Medicaid coverage during the pandemic remained so regardless of changes to their incomes or living situations.

The redetermination process is playing out in states around the country and each state sets up their own process to implement reviews of who should still be covered. Of the more than 104,000 adults and children whose coverage was terminated in Montana since the start of the process, nearly 65,900 lost coverage because they failed to return information requested by the state to determine their eligibility.

About 30% lost coverage because they were no longer eligible. More than 80,720 have had their coverage renewed.

Jon Ebelt, a spokesperson for the state health department, said Monday that the redetermiation process has started for more than 90% of those covered by Medicaid and that the rate of automatic renewal has increased over the timeline of the process.

Ebelt also said the process started with those less likely to be qualified for the program, meaning disenrollment rates would be highest at the start of redetermination and lower as it went on.

Last week the state health department said it would not stop the redetermination process after a request from two Democratic legislators who were concerned about the rates at which people have lost coverage.

Monday’s letter strongly urges Montana to use more federal flexibilities to keep people covered.

Only two states — South Dakota and Idaho — saw higher disenrollment rates of children, both dropping 27%. Montana, New Hampshire and Arkansas all saw enrollment drop by 18% from March to September.

The federal government has allowed for nearly 400 flexibilities for states to make renewals easier, and Montana has adopted only three of those measures, according to the letter from Becerra. He urged consideration of additional measures such as more automatic renewals using data from other federal programs like the Supplemental Nutrition Assistance Program, or SNAP, or Temporary Assistance for Needy Families, or TANF.

Becerra also urged Montana to improve its outreach by doing things like on-the-ground contact through schools and pediatrician offices, as well as improving call center operations.

“Because all children deserve to have access to comprehensive health coverage, I urge you to ensure that no child in your state who still meets eligibility criteria for Medicaid or CHIP loses their health coverage due to ‘red tape’ or other avoidable reasons as all states ‘unwind’ from the Medicaid continuous enrollment provision that was in place during much of the COVID-19 public health emergency,” Becerra wrote. “This is especially important for communities of color and underserved communities across the country — we know more than half of all children in Medicaid and CHIP are Hispanic, Black, Asian/Pacific Islander, or American Indian and Alaska Native.”

Earlier this year the state health department said it was working to improve its process, especially call center operations, and contended the department is going through the process in a timely and accurate manner approved by the federal government.

That was in response to an August letter from the federal government raising concerns about things like long call times that it said may have led to people unnecessarily losing coverage and raising concerns of "potential non-compliance with federal requirements."

Ebelt said Monday. the department completed updates to the Public Assistance Help Line by October and call wait time is now under 5 minutes. Wait times also dropped 13% between September and October and call abandonment rates dropped nearly a quarter. Ebelt also those who have missed the initial deadline for the process can still return paperwork to gain coverage if qualified.