Kim Gillan

Plain and simple — people get sick. Right now, more than 250,000 predominantly low-income Montanans get help with health care through Medicaid — a state-federal partnership. Montana has overall and primary responsibility, while the Feds pick up most of the costs, averaging 80% (of total Medicaid spending).

In 2022, the Federal government provided $1.8 billion to cover health care for Medicaid-eligible Montanans who live in every county across the Big Sky. Remarkably, two-thirds of Medicaid recipients live in our rural communities.

So, what is Medicaid, and who does it serve? Not only does Medicaid fund health care services for our lower-income neighbors including children, families, and pregnant moms, but it also covers those with serious disabilities. By reducing the number of uninsured, Medicaid has also helped keep health care insurance costs down for everyone while pumping money into Montana’s economy.

The Medicaid reimbursements for rural and urban health care providers keep the doors of health care facilities open and help retain health care providers. Small businesses also benefit from Medicaid, as they often cannot afford to provide health insurance for their employees — whether they work full or part-time.

Medicaid expansion is a critical program for our Native American Montanans. The Indian Health Service continues to be woefully underfunded; a recent series of newspaper articles illustrates the health care challenges facing those who reside on reservations. Medicaid has greatly boosted services to Native Americans, allowing them to access a broader range of health care providers. The Federal government reimburses the care provided to Native Americans on Medicaid at 100%!

Despite the benefits of Medicaid, we now have over 120,000 Montanans — 18% of kiddos — who have lost Medicaid coverage due to DPHHS’s procedural snafus. The end of the COVID Public Health Emergency necessitated each state to review eligibility for Medicaid. That’s reasonable; however, Montana launched a process that is difficult, confusing, and sometimes impossible for people to reapply or maintain eligibility.

The result: almost one in every three Medicaid recipients has been denied not because of eligibility but 64% for technical or procedural issues. Montana now has among the highest and worst records in the nation for terminating health insurance for children. Disgraceful.

Reports indicate 4 to 6-hour telephone waits and multiple “tries” for Medicaid recipients to provide documentation to keep their insurance. Unbelievably some folks did not know their coverage had been terminated until they arrived at the doctor’s office. What happened to Gov. Greg Gianforte’s political promises of less bureaucracy?

Alarmed by Montana’s record, federal health care authorities have twice requested changes to this process — echoing a chorus of local health care providers (such as the Montana Chapter of the American Academy of Pediatricians) asking for a 30-day pause to stop children from losing their coverage. Meanwhile, state officials seem hell-bent on purging the Medicaid rolls, to the detriment of people’s health as well as our economy.

Is this purging a signal of things to come? Medicaid expansion must be renewed during the 2025 legislative session. Montana’s Medicaid program is not plagued by fraud and abuse — exactly the opposite. It’s bewildering to think about the consequences of this purge. Ironically there is an ongoing major mental health reform initiative, aimed at expanding access. Yet, many of those losing Medicaid need mental or behavioral health services — but will no longer be eligible.

The governor is taking Montana backward, not forward. Is this the Montana we want for our children, those less fortunate, or folks in rural areas?

Please call Governor Gianforte and your legislator to tell them to stop dismantling Medicaid. And, then ask how in the heck this administration intends to replace the $1.8 billion in Federal Medicaid program funding and keep providing health care to all the Medicaid-eligible moms and kids.

Kim Gillan is a former legislator (1997-2012).  Gillan was US Health and Human Services Regional Director for Region 8 2013-2017 and worked in Healthcare Regulatory Policy for a large, midwestern healthcare system (Sanford).