Nicole Girten

(Daily Montanan) Thousands of Montanans lost Medicaid coverage, not because they weren’t eligible, but due to “unapproachable and unmanageable” administrative barriers at the state health department.

That’s according to a letter signed by 66 national and state organizations sent to Gov. Greg Gianforte last week asking him to include money to add additional staff to the Department of Public Health and Human Services and update outdated software, among other requests, in his budget proposal for the 2027 biennium.

The Medicaid redetermination process took place following a freeze on disenrollments during the Covid-19 pandemic, and took a total 135,000 enrollees off of Medicaid. The state’s redetermination dashboard cites the most frequent reason for disenrolling as a lack of correspondence with the department. Many former enrollees who may still be eligible now have to apply for Medicaid again for health coverage, with longer-than-usual wait times and Medicaid providers struggling to make ends meet as applications are processed.

The letter suggested consumer advisory groups, focus groups, surveys, and end-user testing to improve the state’s communication with clients – and said health department staffers should use plain language with clients to help reduce delays.

The state health department previously told the Daily Montanan it meets all federal standards for processing both redeterminations and new applications. Spokesperson for the department Jon Ebelt said Monday it is taking the requests in the letter under consideration in its budget planning.

“The letter makes specific budget requests, and at this time, DPHHS is in the preliminary stages of the executive budget planning process for the upcoming legislative session,” Ebelt said in a statement. “DPHHS appreciates the feedback and suggestions included in the letter and will consider them.”

The letter was addressed to Gianforte, but the Governor’s Office on Monday deferred to DPHHS in response to questions. DPHHS Director Charlie Brereton, as well as Human Services Executive Director Jessie Counts, Medicaid Chief Financial Manager Gene Hermanson and Director of Budget and Program Planning Ryan Osmundson were copied on the letter as well.

Jackie Semmens with the Montana Budget and Policy Center, told legislators Thursday the organizations who signed onto the letter included food pantries, healthcare providers and faith organizations – places people turn to when they “can’t get the benefits they qualify for in a timely manner.”

“These organizations see people coming to food pantries when they are forced to choose between paying out of pocket for prescription or feeding their family because their Medicaid determination is delayed,” Semmens said. “These 60 plus organizations have seen firsthand how strapped the department has been during the past year, which is why they have joined together to ask the governor to improve access to public assistance.”

Organizations include the Montana Food Bank Network, the Fort Peck Tribal Health Department, Montana Head Start Association and the American Heart Association.

The letter, sent June 17, said the health department cuts made in 2017 led to 19 public assistance offices across the state to close and resulted in pressure on the staff that was left.

Medicaid unwinding exacerbated these existing issues, the letter said, and “highlighted the ways in which Montana’s safety net is outdated, inaccessible, and cumbersome for those most in need.” The organizations asked that as the governor’s administration develops its 2027 biennial budget, they invest and modernize access to Montana’s safety net services.

Prior to each legislative session, the governor releases a budget with proposals for spending for the upcoming two fiscal years. The legislature ultimately has the power to appropriate funds, but the budget is a public statement of the investments the executive office wishes to make and approve. The legislature will meet again in January 2025.

The organizations want to see more options for in-person assistance, which could include the reopening of rural public assistance offices. Applications completed in person are less likely to contain errors, the letter said, and would reduce procedural delays.

“In-person assistance is an essential lifeline for elderly, disabled, and rural individuals,” the organizations said.

The state health department’s website to apply for safety net services like Medicaid or food assistance is hard to navigate, the letter said, and during the unwinding process, phone lines were jammed with people having to wait hours to speak to someone. The organizations believe the solution to the problems is better staffing at the department, although their letter did not specify how many more employees they believe are needed.

“With rural Montanans relying on these means of application, Montana should make significant investments to improve their functionality,” the letter read.

The letter said understaffing was what led to procedural delays during the Medicaid unwinding. Ebelt previously listed limited staff as one reason for Medicaid delays, along with prioritization for individuals with current inactive coverage as well as verifying previously unreported resources. He said the state meets the federal standard of paying 90 percent of “clean claims” (claims not needing additional verification) within 30 days, and 99 percent of “clean claims” in 90 days.

About 9% of cases are still pending eligibility, Counts told legislators, translating to a little under 20,000 cases.