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Montana health department pushes back on legislators' request for data on Medicaid enrollment – Daily Montanan [1]

['Keila Szpaller', 'More From Author', '- January']

Date: 2024-01-18  

Telephone hold times can take three to six hours, but assisted living director of operations Michael Coe said he knows one way to get a resident bumped up the health department’s priority list for a Medicaid waiver.

“Really, the only way to get service for somebody is to threaten to evict them,” said Coe, with Caslen Living Centers, of people who have no source of money.

The waiver allows a person who might be eligible for a nursing home through Medicaid to live in an assisted living facility.

Thursday, the interim legislative committee on children, families, health and human services heard updates from the Department of Public Health and Human Services on Medicaid redetermination and other topics.

DPHHS Director Charlie Brereton said the process is in its final month, and the department has started reviewing eligibility for “almost all” of the 330,000 Montanans who had coverage during the COVID-19 pandemic.

“We are in the last and final month of our 10-month redetermination or unwind process,” Brereton said.

DPHHS reported fewer people enrolled in Medicaid than anticipated through October 2023, 6% lower for traditional Medicaid and 12% lower for expansion.

However, Brereton said “there may very well be a bounce-back period” ahead as people potentially reapply and become enrolled again. Brereton also said just a handful of people have alleged inappropriate terminations through the formal hearing process.

During the pandemic, the federal government ensured people on Medicaid would retain coverage without having to prove eligibility. Last April, however, that protection ended, and states are confirming people on public insurance are in fact eligible for it.

The process in Montana has been messy, drawn out, and financially stressful, according to reports from many health care professionals during the last few months. Thursday, the committee continued to hear concerns from the public, and legislators asked questions of their own.

Rep. SJ Howell, who led the hearing, said the committee sent DPHHS a long list of questions after a hearing in November, and the department answered most of them, but it didn’t provide some statistics. The Missoula Democrat wanted to understand the reason.

Brereton said employees are under water, and the data legislators wanted was not easy to provide quickly. He said information lawmakers wanted would require “custom reports.”

“We are strapped,” Brereton said. “The committee knows — frankly, Montana knows — what a heavy lift this is for DPHHS. And so I am essentially being sensitive to my team’s time.”

Howell agreed with the agency’s priority of ensuring Montanans who are eligible have coverage. However, they pressed for clarity on how the committee could be involved and receive information given the questions legislators are hearing from constituents and ones they have of their own.

“What are you reporting to CMS already, for example, that wouldn’t be an additional effort that we could tailor our request to?” Howell said.

Brereton said spring would be a good time to discuss the matter some more. He said he would be willing to meet in the future, but staff are already working extra duties.

“I simply do not have the FTE to assign to these data requests at this point in time,” Brereton said (FTE stands for full-time equivalent, or staff hours).

Howell said they would welcome a conversation and also appreciate the “capacity crunch” that DPHHS is in.

“I do want to balance that very real capacity issue with our constitutional right to know and ensuring that the committee gets access to the information that we need,” Howell said.

Later in the meeting, Rep. Mike Yakawich, a Billings Republican, said he had asked 12 questions, and DPHHS had provided him 12 pages of responses, and he hadn’t had time to review everything, but appreciated the effort.

Yakawich also praised an announcement the Montana State Hospital, which lost federal certification and funding in 2022 after a failure to prevent deaths and falls, plans to seek recertification later this year: “I cannot go without saying applying for recertification in December is awesome for the Montana State Hospital.”

When it comes to work on Medicaid, Howell and health care professionals have acknowledged staff at DPHHS are over capacity and helpful when available, and earlier, at least one legislator requested a pause on redetermination to allow the agency to catch up on applications. Brereton declined.

In the meantime, providers continue to report problems.

Rose Hughes, with the Montana Health Care Association, said 18 facilities contacted her from Jan. 8 to 17 about long waits for reapplications — even though DPHHS is meeting its 45-day target.

“But the facilities that are dealing with this are saying three to six months,” Hughes said, noting the facilities and DPHHS may be counting from different starting points.

Either way, she said, the payments being held up as a result amount to at least $2.3 million: “So it’s not a small amount when you’re providing services and not getting paid.”

She too said facilities reported “very long wait times” on the phone of “hours, not minutes,” plus months to get a caseworker assigned, lost applications, and other issues. Hughes said workers are clearly working hard and are are helpful, but the problems exist, too.

Coe said families and providers end up in the dark and confused about the status of their applications as well. He suggested DPHHS offer a way for people to track applications online so they can see a reason for a delay, for instance.

“That would save us hours being on hold trying to get that answer,” Coe said.

Rep. Jennifer Carlson, a Manhattan Republican, also quizzed Brereton with constituent questions: “We get a lot of questions from the public.”

She requested a breakdown of the number of children who have lost coverage by county in Montana, and Brereton said he had it handy and would provide it electronically. DPHHS did not have the information available Thursday.

This week, KFF reported data showing Montana saw an 18.5% drop in enrollment for children in Medicaid, one of the steepest declines in the country, from March to September 2023. KFF noted the average decline is 5.5%.

“Medicaid eligibility levels are higher for children, raising concerns that they may be losing coverage and becoming uninsured despite remaining eligible,” KFF said in its analysis. “Medicaid covers 8 in 10 children living in poverty and over half of Black, Hispanic, American Indian, and Alaska Native children.”

Carlson also wanted to know what would happen with a child who needs ongoing behavioral health treatment but can’t get an appointment because their parent or guardian didn’t go through the redetermination process.

“I just don’t want to see them left in the cracks because they still need ongoing care, but the person responsible for them is not managing the need. And so what can we do to help those people?” Carlson asked.

Brereton said he knows many of those circumstances exist. He said the provider network in Montana is supportive and recommended the child’s provider work closely with the parent or guardian to offer assistance.

“We as an agency are extremely extremely grateful to the health care providers across the state who have already participated in this process and helped those families and Medicaid members navigate the process,” Brereton said.

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