Those who spoke Wednesday in opposition to a proposal to end continuous eligibility on part of the state’s Medicaid program said it would cut people off from accessing life-saving medical care.
Opponents at a public comment hearing also questioned what Montana’s new plan for checking if people are qualified to receive coverage would be if the change is made.
Continuous eligibility means people who are qualified for a program remain qualified for a year. It was put into place to prevent what's called churn, or when people move from being qualified to not and then back to qualified. That happens because of fluctuation in pay from things like overtime hours or seasonal work or change in household composition from moving.
The two programs the state Department of Public Health and Human Services is seeking to end continuous eligibility on are Medicaid expansion, which covers more than 100,600 Montanans earning up to 138% of the federal poverty level, and the Waiver for Additional Services and Populations (called WASP), which includes those with a severe disabling mental illness who meet income and other qualifications.
No one spoke in favor of the change, which would be made through a waiver to the state’s Medicaid program and needs to be approved by the federal government, during an hour-long meeting Wednesday.
While attempts to pass a policy bill to eliminate continuous eligibility were voted down with bipartisan opposition in the state legislative session that ended in April, lawmakers passed a budget that accounts for its elimination.
That was done by budgeting for a higher reimbursement rate from the federal government for Medicaid expansion. The state is reimbursed 89% for services but that would increase to 90% if continuous eligibility was eliminated. That bump is reflected in the state budget.
Opponents who spoke Wednesday pointed out lawmakers did not pass a bill outside the budget to direct the health department to eliminate continuous eligibility. One person cited the state’s initial waiver to expand Medicaid back in 2015 lauded continuous eligibility, saying “nearly one-third of low-income families experience frequent income fluctuations that cause ‘churning.’ Churning leads to coverage gaps and discontinuities in the insurance plans and provider networks available to consumers.”
Heather O'Loughlin, co-director of the Montana Budget and Policy Center, spoke against the change.
“The end of 12-month continuous eligibility will disproportionately impact Montanans facing additional barriers to meeting increased paperwork and eligibility determinations,” O’Loughlin said. “This includes individuals living in remote areas with lack of consistent access to internet, those facing substance use disorders or mental health issues, and individuals working part time seasonally, or dealing with inconsistent work schedules.”
Other opponents said a person’s income could fluctuate with seasonal employment or overtime hours that put them over the income limit one month but not the next.
SJ Howell, the executive director of Montana Women Vote, raised concerns over not knowing what kind of qualification checks the state health department would put into place if it eliminated continuous eligibility. The proposal would change how often the eligibility of a person is checked but does not change the qualifications to qualify for Medicaid programs.
“We have not seen a clear proposal of what will replace 12-month continuous eligibility, and without this information, it's really hard to understand what the impact will be on the lives of Medicaid enrollees,” Howell said.
Jon Ebelt, a spokesperson for the state health department, said Wednesday there weren’t specifics available about what the new approach would be. Details would be available closer to implementation, he said, and communicated to Medicaid clients.
Kristin Page-Nei, the government relations director with the American Cancer Society Cancer Action Network, said if cancer patients lose health care coverage due to small and temporary changes in their income, it would be difficult or impossible to continue their treatment.
“For those cancer patients who are mid-treatment, a loss of health care coverage could seriously jeopardize their chance of survival. Being denied access to one cancer care team could have a significant impact on an individual's cancer prognosis and the financial toll that the loss of coverage would have on individuals and their families could be devastating,” Page-Nei said.
Joe Rosette, the chief executive officer of Rocky Boy Health Center, said Medicaid expansion has allowed Native Americans to begin to adequately address health disparities that lead to that population dying nearly 20 years earlier than whites in Montana. Just over 16% of those covered on Medicaid expansion are Native American.
Removing continuous eligibility during the pandemic would further erode any gains, Rosette said.
When the change, if the waiver is approved by the federal government, would take effect is unclear. The state is asking for a retroactive implementation date of July 1, to reflect the start of the fiscal year when the new budget started. But it also said it would not implement any changes until the federal state of emergency tied to COVID-19 expires, because if it made the change before then Montana would lose out on additional federal money it’s receiving because of the pandemic. The Biden administration extended that for another 90 days on July 20.
The public comment period on the proposed change is open through Aug. 31. People can comment by sending mail to Department of Public Health and Human Services, Director’s Office; 111 North Sanders Street; P.O. Box 4210; Helena MT 59604; c/o Mary Eve Kulawik; by calling 444-2584, sending a fax to 444-1970; or emailing firstname.lastname@example.org.
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.