Nearly half of Montanans whose Medicaid eligibility was reviewed in April lost coverage, according to new information published Tuesday by the state health department.
The summary is the first publicly available glimpse into how Montana is fairing during the national “Medicaid unwinding” — the mass reevaluation process for millions of people since the federal response to the pandemic froze public insurance rolls in place three years ago.
In total, 15,471 Montanans assessed in April had their Medicaid coverage discontinued, with the vast majority, just over 72%, losing coverage because they “failed to provide requested information,” according to the department’s Montana Medicaid Redetermination dashboard. Twenty percent — 3,094 individuals — were determined to no longer be eligible for the public health insurance program.
Of those reviewed in April, the health department reported 9,112 people, or 28%, had their Medicaid coverage renewed. The eligibility of another 7,013 individuals is still being considered.
More than 324,000 people were covered by Montana Medicaid as of March 2023, providing a framework for how many will be reevaluated over the next seven months. The health department has said its redeterminations will conclude by January 2024.
Roughly a million people have lost coverage nationwide since the federal public health emergency designation was lifted in April and states began reviewing Medicaid rolls. Initial data about people losing eligibility, particularly because of unreturned paperwork or other administrative hurdles, prompted U.S. Department of Health and Human Services Secretary Xavier Becerra to issue a letter to state governors urging them to revise their redetermination processes.
“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Becerra wrote.
A spokesman for the state health department did not directly respond to the strategies outlined by Becerra in an email Tuesday, but defended the lengths to which state employees have gone to contact Medicaid enrollees, encourage them to update their contact information, and clearly explain the renewal process.
“Individuals who received a redetermination packet requesting additional information or verifications of information on file were sent follow-up reminders and texts to return the redetermination packet,” spokesman Jon Ebelt wrote. “Because DPHHS prioritized individuals most likely to no longer be eligible for Medicaid (based on available information), it isn’t surprising that a number of redetermination packets were not returned. When people are aware that they no longer meet eligibility criteria, they would not necessarily make the effort to complete and return paperwork.”
Ebelt said the department expects to see higher rates of coverage ending in the first four months of the redetermination process before moving on to evaluate the status of people who are “aged, blind or disabled,” populations covered through Medicaid waivers. He did not immediately respond to a question from MTFP about how many of the individuals who lost coverage in April were children.
Olivia Riutta, the director of the nonprofit health insurance navigating group Cover Montana, expressed concern about the department’s summary in a written comment Tuesday.
“These numbers are real people from every corner of Montana. These are folks who qualify for coverage, who need coverage, and for some reason they didn’t understand or weren’t able to make it through our current systems and process. Many won’t realize they have lost coverage until they try to access care,” Riutta said. “We hope that DPHHS uses this data to evaluate and improve their systems and process to ensure that Montanans who qualify, stay covered.”
Another 40,334 people were evaluated for eligibility in May, according to the state dashboard. Of those, roughly 20% have had their coverage renewed and another 35% are still being evaluated. While the state has not published numbers of people who lost coverage in May, the process has continued.
Liam Harry, a 30-year-old graduate student in Missoula, told MTFP he was notified by the department in mid-May that his coverage would end June 1. He said his total income from seasonal jobs in the prior year put him over the eligibility cap for an individual, even though that figure might not reflect his current employment status or income.
“By the time I go through that process, my income could have changed again,” said Harry, who often works as a winter ski instructor, summer soccer coach, university research assistant and a part-time state parks employee. “For me it’s just a revolving door.”
Harry said he was able to enroll in a low-cost health plan through the Health Insurance Marketplace and experienced only a small gap in coverage. His roughly $30 a month payment, he said, was a tradeoff that afforded him more stability than he had on Medicaid.
Families have also been impacted. Kerstin McLeod, 34, and her husband are raising three daughters in Arlee, all of whom lost coverage June 1. McLeod assumes it’s because the family converted part of their property to a short-term rental, giving them an additional source of income that made them ineligible.
“Medicaid has just been really instrumental for us to be able to survive,” McLeod said in a June interview. “My husband works for a small company in town that doesn’t offer health insurance. We’re just kind of at a crossroads now where we’re trying to figure out what even is out there.”
While she’s continuing to look for coverage plans through the marketplace, McLeod said the process is overwhelming. Some people have recommended she look into health care sharing programs — a non-insurance type of coverage where members help pay certain health care costs. McLeod said she hasn’t decided what coverage option works best for them. The family is paying out-of-pocket costs in the meantime, she said, including over $1,000 in dental work for one of her daughters.
Other Montanans are keeping an eye on their anticipated renewal month, viewable through their online state accounts, with trepidation. Jessica Cash, a 48-year-old office manager in Butte, gained Medicaid coverage during the pandemic when her hours were cut. She’s long struggled with diabetes, high blood pressure and other health issues, she said, but her overall health since enrolling in Medicaid has much improved. Now that her hours have increased back to full-time, Cash expects to lose her public insurance, and many of her new health resources, come September.
“It’s a very scary feeling,” Cash said. “Especially when everything across the board, mentally and physically, is just going so well.”