Darrell Ehrlick

(Daily Montanan) Data released by the Montana Department of Public Health and Human Services after demands by Democrats in the Legislature show that Montanans are losing Medicaid health insurance at a rate higher than expected, and many of those people are children and Native Americans. Moreover, the report shows that majority of Montanans losing health coverage is due to administrative reasons, like incomplete paperwork, not necessarily because they no longer qualify.

In recent months, Democrats have demanded more data from the DPHHS, voicing concerns about the high rate of people being disenrolled from the federal program. Department chief Charlie Brereton pushed back in some of those meetings saying that his department didn’t have adequate staff to handle the requests.

However, in a dataset released this week by department, it shows that more than 127,000 residents have lost coverage, a number much higher than projected by federal government officials and other healthcare organizations. Many of those kicked off coverage are children and Native Americans, the data shows.

Montana is both similar to and different from other states during the Medicaid “unwinding” process. Unwinding refers to the process of redetermining eligibility for the federal health insurance after the COVID-19 pandemic sent numbers of Medicaid-eligible residents rising rapidly. After the national emergency concluded, states could restart the process of redetermination — or seeing if residents still qualified for the program.

Montana added an extra layer when the 2021 Legislature also ceased the “continuous eligibility” period the state had adopted since Medicaid’s expansion in the Treasure State. Continuous eligibility meant that once a resident qualified for Medicaid, they were covered for as long as a year without needing to reverify that they still met the requirements. However, fears about abuse or fraud in the Legislature led the Republican supermajority to change to a faster redetermination cycle, meaning state officials could essentially recheck eligibility more than once per year.

Initially, the Kaiser Family Foundation projected the number of people who would lose coverage after the “disenrollment” process began following the end of COVID. Because state demographics varied widely, KFF estimated between 8% and 28% would lose coverage. In Montana, KFF estimated that would translate to approximately 59,000 people. Montana’s numbers have more than doubled that estimate.

According to the state, 68,924 adults were added to Montana’s Medicaid rolls, and that same data shows that around 90% have lost coverage in the previous year.

The combination of those changes has led to Montanans being booted from the program at a much higher rate. The numbers released by the DPHHS this week show how deeply those programs have been cut, worrying Democrat lawmakers. Among the statistics that legislative leaders highlighted was the high percentage of people who have lost coverage due to an administrative reasons — likely incomplete or missing paperwork.

According to federal Centers for Medicaid and Medicare statistics, Montana determined that 5,936 residents were ineligible for Medicaid during the month of November, the last month for which the federal government has statistics, and that 4,925 — or 83% — were cut from the program because of administrative reasons.

During the past year, 35,797 kids have lost insurance coverage and 12,781 Native Americans lost coverage as well.

“For months, Democrats have urged the Governor to fix his deeply-flawed process for redetermining Medicaid eligibility, or risk tens of thousands of Montanans losing health care coverage they still qualify for,” said House Minority Leader Kim Abbott, D-Helena. “Now we see how the burden of his carelessness is falling hardest on Native folks, children, and seniors. His failure of leadership is devastating for Montana families, for our healthcare system, and for our entire state.”

Representatives for the Montana Department of Public Health and Human Services did not respond to inquiries for comment from the Daily Montanan.

According to CMS, 53% of people nationally who went through the redetermination process were approved in November, with only 15% being denied because of an administrative reason. In Montana, only 33% of residents were approved with 25% being denied because of an administrative reason.

Nationally since the end of the COVID emergency, 52% of people who went through the redetermination process have been eligible and only 18% have been denied because of an administrative problem.

Data from CMS also shows that concerns about the state’s call center, which helps renew or assess Medicaid eligibility, has not significantly improved, despite a public outcry in which Montanans said they had waited for hours on hold at a call center, only to be disconnected when the system “timed out.” Some Montanans have reported being on hold for hours, or even days — a problem that DPHHS said would resolve itself after the initial wave of redeterminations were completed.

However, a comparison a federal data shows little improvement. For example, in July 2023 Montana’s call volume was at 27,946 with an abandonment rate of 44% — meaning that nearly half of the people were disconnected or hung-up before speaking with a representative. The average call wait time was 31 minutes.

Call volume in Montana increased in November to 36,640 calls, with an average wait time of 30 minutes and an abandonment rate of 38%.

Montana ranked No. 46 among all states for average call-center wait time with only New Mexico, Florida, Nevada, Tennessee and Missouri being worse. And only Florida and Missouri had a higher percentage of abandoned calls.