Lessons learned from Medicaid difficult redetermination
(Daily Montanan) One healthcare provider is still waiting on a $700,000 Medicaid payment from the health department — but nine programs that support behavioral health have opened or reopened since September because of higher reimbursements.
Those are examples of the highs and lows professionals who work in the healthcare field shared with a legislative budget committee last week.
During the legislative session this year, professionals and members of the public said facilities that care for people were closing because Medicaid rates were too low — and lawmakers boosted rates.
At the meeting last week, Mary Windecker, head of the Behavioral Health Alliance of Montana, said since September when rate increases started rolling out, 64 more staff have been hired by various agencies in her field, and nine programs have opened or reopened.
She said any survey the Legislative Fiscal Division conducts will be more comprehensive because it will include organizations beyond members of her alliance, but she praised the results.
An adult group home reopened in Helena, a children’s group home reopened in Boulder, and a substance use disorder service is opening in a previously underserved rural county, among other examples, she said.
“It’s been very successful,” Windecker said.
She said she anticipates additional facilities that closed during the COVID-19 pandemic will reopen as well as part of a commission working on how to invest $300 million in community-based behavioral health and developmental disabilities.
This month, following an ambitious but rocky Medicaid redetermination process and increases in provider rates, the interim budget committee heard updates from the Department of Public Health and Human Services. It also heard comments from leaders in health care who are on the ground — including ones seeing significant challenges.
A couple of people said they’d like to know whether Montana could learn lessons from the redetermination process given the state surely will need to verify again in the future that people on state insurance are qualified for Medicaid.
Matt Kuntz, head of the National Alliance on Mental Illness in Montana, said redetermination has been hard on his members.
He did not name specifics, but other professionals who work in health care have talked about delays in payments as clients and providers wait to learn if they still have insurance.
“But I think what we would really ask is can we learn the lessons? Because this is not the last time that we’re going to want to need to know who qualifies for Montana Medicaid,” Kuntz said.
Even if the lesson is as simple as, “we’re really bad at call centers,” because improvements can be made, he said.
Earlier this year, the Centers for Medicare and Medicaid Services said Montana’s hold times were too long — 42 minutes on average. At the meeting this week, DPHHS reported hold times for Medicaid-only callers were averaging fewer than five minutes.
“There’s got to be some lessons learned that come out of this difficult process,” Kuntz said.
As the state moves ahead with other initiatives, Kuntz also cautioned that one-time-only money is difficult. A program might look like it’s working right away, but then get mothballed, and he said Montana needs to think about sustainability.
To support ongoing funding, Kuntz suggested putting some money in a long-term trust to support Medicaid matches in the future.
Sarah Corbally, with Healthy Mothers, Healthy Babies: the Montana Coalition, and the Montana Home Visiting Coalition, said she agreed with Kuntz’s remarks about one-time only funding and the need for sustainability as the state draws on federal money to support programs.
Corbally also said investments in families earlier on when it comes to prevention and wellness make a difference down the road, and she knows the models work, both as someone who works with families and as a former prosecutor.
“We could really put these services in place and see a downstream impact, maybe not tomorrow, but in the future on the state hospital admissions,” Corbally said.
Corbally also requested help with getting contracts signed and payments to home visiting providers. She said some have served people in October, November and December but still don’t have payments.
“I think it’s starting to be a bit of a backlog in the money,” Corbally said.
Rose Hughes, with the Montana Health Care Association, also said some of her members are waiting on big payments — as much as $300,000 and $700,000 — because Medicaid redeterminations are pending.
She said one facility counts 20 people who are still listed as pending. But most people in a senior care center aren’t going to have a huge increase in their income all of a sudden, she said, so it doesn’t make sense to remove them from Medicaid because of routine paperwork.
“It’s a tremendous cash-flow problem,” Hughes said.
The association represents most of the nursing homes in Montana — about 50 out of 60 — and roughly 100 assisted living facilities.
Hughes said she is grateful to staff at DPHHS, who are diligently working with providers to try to get them paid, and she said the situation is slowly improving.
“The staff is doing their best to put out fires, but we have so many fires,” Hughes said.
Hughes also said an issue with the way claims are processed retroactively is bogging down the system, and she too suggested the state could learn lessons that will help going forward.
Given the way the legislative cycle runs, she said it’s likely not the last time providers will be billing for new rates retroactively.
“I agree with Mr. Kuntz. Maybe there’s something to be learned for the future so that we don’t go through this again,” Hughes said.