(C) Daily Montanan This story was originally published by Daily Montanan and is unaltered. . . . . . . . . . . 'Four-alarm fire': Lawmakers concerned Montanans losing insurance faster than expected – Daily Montanan [1] ['Keila Szpaller', 'More From Author', '- December'] Date: 2023-12-13 Montanans are losing insurance through the state faster than expected, and at least a couple of legislators are concerned that people who are eligible for coverage don’t have it. Sen. Christopher Pope, D-Bozeman, characterized the situation as a “four-alarm fire” that started in January and hasn’t let up. But the head of the Department of Public Health and Human Services said he believes disenrollments have largely been correct. Nearly 19,000 people who were expected to be insured through Medicaid weren’t covered as of September, according to a report Wednesday to a legislative budget committee. The total reflects 5.4% fewer traditional Medicaid members and 9.6% fewer expansion members than projected would have coverage as of September, according to the report from the Department of Public Health and Human Services. In April, Montana kicked off Medicaid redetermination following a freeze during the COVID-19 pandemic where the federal government allowed people to retain coverage without proving eligibility. Since then, 104,097 people have lost insurance, and the process of figuring out whether people should have coverage has been plagued by difficulties in Montana. Wednesday, DPHHS reported improvements to some earlier problems, such as a decrease in long hold times on the phone. As of this month, DPHHS said the redetermination process had been initiated for more than 90% of people covered by Medicaid. However, a couple of Democratic legislators said the situation constitutes an emergency, it puts Montana in a bad light compared to other states, and it is having a negative effect on people’s health. Pope and Rep. Mary Caferro, D-Helena, both asked DPHHS if it would consider pausing the redetermination process or extending the window to complete it in order to get eligible Monanans enrolled. An estimated 72,000 people have lost coverage for procedural reasons, not because the department found them to be ineligible, Caferro said, citing data from the Centers for Medicare and Medicaid Services. Federal data also show an estimated 41,513 applications are still being processed, and 40% of renewals are pending, above the national average of 22%. Some 40% of renewals are still pending. DPHHS Director Charlie Brereton, however, said he would not be pausing the process. He said because of the way reenrollment works, the agency will not know until late April or early May whether people who qualify for Medicaid aren’t insured. However, Brereton also said he believes the numbers reflect the state of the economy in Montana, with low unemployment rates and wage increases he said keep up with inflation. And he said people have another chance to enroll if they didn’t provide paperwork the first time. “I’m confident in our redetermination process,” Brereton said. “I do believe that many of the Medicaid members who were disenrolled were disenrolled correctly.” In April, an estimated 330,000 people were enrolled in Medicaid. The report to the interim legislative committee on health and human services noted as of September 2023, traditional Medicaid had 149,900 people enrolled, and expansion had 96,659 people enrolled. Pope asked if current numbers were available as opposed to enrollment numbers from September, 90 days ago, and Brereton replied they were not. But, Brereton said if someone who lost coverage provides needed paperwork within a 90-day window, they will be covered retroactively. Pope praised the retroactive payments: “I think that’s a really positive thing.” However, Pope also said it’s important to get eligible people covered, and although some systems are improving, his constituents are concerned about Montana’s inability to get people enrolled compared to other states. And Caferro said Montanans are experiencing negative health effects as a result of the lag: “There are Montanans who are being denied health care because they do not have coverage as identified in the system.” She said she’s heard of children whose health has deteriorated so much, they are now required to have surgery. She said the parents are doing their best, but the lack of healthcare creates problems. She also said Montanans are losing coverage at a rate that’s higher than the national average, 35% compared to 26%, and the renewal rate here is lower, 25% compared to 51%, citing federal data. Caferro said she also wanted to know how DPHHS was reaching out to specific populations such as those with Alzheimer’s disease or people in nursing homes and assisted living facilities. She said the gap has negative implications for the business model of providers. “These are serious problems, and people are hurting,” Caferro said. Although Brereton said he would not pause redetermination, he said DPHHS has been working in an “efficient but high-quality manner.” He said the agency is doing outreach to organizations, and it’s also targeting some cases that are more complex. Earlier, CMS said Montana’s hold times for phone calls were too long — 42 minutes on average — and Brereton said Medicaid-only calls are averaging fewer than five minutes of hold time. He said wait times for call center lines dropped 13% from September to October, and “abandonment rates,” or hang-ups before connecting, dropped 23% in the same period. Additionally, terminations for procedural reasons dropped from May to November from 36% to 25%, Brereton said. And he said “ex parte” renewal rates, or automatic renewals, are increasing, from 21% to 33% during the same period. “The state of Montana had the option to move even quicker, and we elected not to do that,” Brereton said. [END] --- [1] Url: https://dailymontanan.com/2023/12/13/four-alarm-fire-lawmakers-concerned-montanans-losing-insurance-faster-than-expected/ Published and (C) by Daily Montanan Content appears here under this condition or license: Creative Commons CC BY-NC-ND 4.0. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/montanan/