Viewpoint: Montana Medicaid is dysfunction by design

Emily Marburger

Dysfunction, denials, disappointment – welcome to Governor Gianforte’s Montana Medicaid. 210,000 Montana adults and children rely on Medicaid programs for their health insurance, and rural hospitals depend on it to pay for care. But under Governor Gianforte’s leadership, Medicaid is increasingly becoming a bureaucratic nightmare.

Delays, paperwork errors, and hours-long wait times have become routine, creating barriers for eligible residents. Working Montanans have responsibilities – like jobs and kids – and don’t have 15 hours a week to sit on hold. In 2023, 81,000 Montanans lost their Medicaid coverage due to paperwork snafus, rather than ineligibility.

Now, Montana is moving quickly to implement new work documentation requirements for adults on the Medicaid expansion program in July of this year—well ahead of the January 2027 deadline.

Sure, work documentation sounds reasonable. After all, who could object to expecting people to work?

But the reality – actual reality, not the one defined by Fox News slop – is different. About 96% of Montanans covered by Medicaid expansion are already working or have a valid reason not to, such as attending school full time or caring for young children. What Gianforte’s new procedures really do is bury Medicaid-eligible people in paperwork, forcing some to lose coverage despite meeting all the requirements.

Federal rules have long required states to process income-based Medicaid applications within 45 days. Yet last spring, Montana ranked worst in the nation, failing to meet that standard more than half the time.

Gianforte’s DPHHS already isn’t serving Montanans well. Adding new administrative hurdles—work reporting requirements, along with increased copays and premiums—will only increase the strain. Gianforte is already hiring additional staff to handle the influx, at a price tag of roughly $4.3 million annually. I don’t think any Montanan wants to invest our hard-earned money in more red tape instead of better health.

For many Montana families, the biggest barrier to maintaining coverage won’t be a lack of work. It will be the notices you miss after a double shift, sitting on hold in the drop-off line, and Gianforte’s bureaucrats deciding whether or not you get insurance this year.

Interruptions in insurance mean interruptions in asthma medications that put kids in life-threatening situations. They mean delayed scans, late cancer diagnoses, and emergency room trips that hospitals struggle to cover themselves. Weaponizing paperwork affects working Montanans just trying to get care for their family.

If you are covered by Medicaid and you lose coverage, reach out to me or your state legislator. We’d like to know. We’d like to help – and to demand that Medicaid does better, for all of us.