Carly Graf, Montana Standard, 01/17/24
Calls from more than 60 organizations to better fund public assistance programs have, some say, not been heeded by the Montana health department, eliciting concern that vital services like health care and food will remain hard to reach for people who need them most.
Dozens of groups penned a letter to Gov. Greg Gianforte in June asking his administration to allocate resources toward the state’s largest agency to hire more staff, modernize systems and expand in-person help. While the governor's budget proposal provides some additional funding to improve public assistance programs, community groups responsible for helping people access those benefits say the measures don’t go far enough.
“The long and short of it is no, it doesn’t address the issue,” said Gayle Carlson, the CEO of the Montana Food Bank Network, which runs food banks across the state.
In its approximately $7 billion, two-year budget proposal, the Department of Public Health and Human Services requested $505,460 to pay overtime to existing staff at Offices of Public Assistance across the state. The proposal does not fund reopening any of the offices that were closed eight years ago after massive statewide spending cuts.
Carlson, whose organization also runs a troubleshooting hotline for people trying to access the Supplemental Nutrition Assistance Program (SNAP), says simply getting in touch with someone from the state has proven to be a challenge. SNAP helps low-income people afford groceries. Similar to a number of other public benefits, SNAP is bankrolled and administered by a partnership between state and federal authorities.
When then-Gov. Steve Bullock, a Democrat, implemented widespread spending cuts to balance the state budget in 2017, he closed 19 Offices of Public Assistance, reducing the total by nearly half. These walk-in locations are staffed by DPHHS employees to support people trying to enroll in government programs that support their basic needs.
Today, only 19 OPA sites remain open, leaving large swaths of rural Montana without nearby access to in-person support.
For example, someone who lives in Ekalaka, where the median age is nearly 63 years old and roughly 20% of the rural town’s residents live below the poverty line, must drive nearly two hours to the nearest office in Miles City.
DPHHS also continues to struggle with hiring, and turnover is common. As of Aug. 1, 2024, the vacancy rate was nearly 14%, though that’s down from 19% two years prior, an agency report shows. A plurality of those open jobs are state-run health care facilities but vacancies plague just about every corner of the agency, including public assistance programs.
Medicaid redetermination, the federally mandated process Montana went through in 2023 and 2024 that required enrollees to reapply for coverage after the pandemic public health emergency ended, brought the fragility of the system into clear view, many community organizations say.
According to final DPHHS data, 115,302 people were disenrolled through the unwinding process, more than the agency projected. Its own data shows that more than 60% of people who lost Medicaid coverage did so because of paperwork errors and failures to submit all the necessary information. Advocates say this number is directly tied to challenges with how the state delivers public benefits.
During that process, the feds raised concerns about Montana’s long wait times for those seeking help through the state’s Medicaid call center. Separately, the Montana Free Press reported that federal officials required DPHHS to implement a corrective action plan for its slow processing times on SNAP applications.
“We have seen thousands of families, children, and individuals lose their health care coverage, not due to ineligibility or the fault of hard-working state employees, but due to administrative barriers caused by a system that is unapproachable and unmanageable for many,” the June letter reads.
When asked about the overtime proposal at the Jan. 13 meeting of the health care appropriations committee, DPHHS staff said the additional hours would ease help line wait times.
Two Republican lawmakers probed for more information on the need for overtime if the redetermination period is over and, theoretically, Medicaid applications would be stabilizing. By contrast, Rep. Mary Caferro, D-Helena, pushed for more clarity on whether these changes adequately addressed concerns raised in the June letter.
DPHHS Director Charlie Brereton touted recently implemented upgrades to the telephone help line, including the creation of a queued callback system and changes to call routing.
Neither required new funding because the agency had enough money in the budget to make the improvements, Brereton explained. He said DPHHS considered making a budget request to hire more coordinators for the help line, but decided to hold off to see how the changes work first.
“I am still concerned that the department is not adequately funded nor asking for funds to enable Montanans who are entitled to benefits — whether it be Medicaid or SNAP or other services — will be well served,” Margie MacDonald of Big Sky 55+, which advocates for aging adults, said in an email.
Brereton also pointed to the department’s request for about $2.3 million over the next two years to hire more positions to support the state’s social safety net, a chunk of which would go toward bolstering the medically needy program. Eligible individuals make more than the Medicaid income limit but have significant medical expenses.
Heather O’Loughlin, the Montana Budget and Policy Center’s executive director, said she continues to hear reports of long wait times and difficulty accessing application information. The organization, a signatory of the letter, appreciates strides the department has made but believes “there is more” that can be done to bulk up public benefits, she said during the committee meeting.
A DPHHS spokesperson declined to comment when asked for further explanation.
An effort to link OPA funding with Medicaid expansion, up for reauthorization this session to avoid its sunset, looks likely to come before lawmakers next week.
House Bill 230, sponsored by Caferro, is a comprehensive bill to reauthorize expansion, including cutting the sunset and work requirements. But it would also direct DPHHS to reopen 10 OPA sites by June 30, 2026, and bolster its online and mobile-friendly capabilities.
"When people need assistance it’s usually at the most vulnerable times in their lives, and they deserve better from the Governor than long waits on hold, a stack of redundant forms to fill out, and no in-person help," Caferro told the Montana State News Bureau in an emailed statement.
The legislation tells the department to prioritize offices in areas with high call volumes and larger numbers of disenrolled Medicaid beneficiaries, and it appropriates $3 million from the state’s general fund to do so.
Gianforte's proposed budget funds Medicaid expansion, and he's expressed his support for work requirements.
Budget negotiations come as Montana lawmakers try to address the rising cost of living and consider possible changes to fiscal policy in the next presidential administration.
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