Democratic lawmakers ask for pause on Medicaid redeterminations as process slows

Dec 14, 2023

Victoria Eavis, Helena Independent-Record, 12/14/23

Two Democratic lawmakers asked the director of the Department of Public Health and Human Services to pause the Medicaid redetermination process in a committee meeting Wednesday. 

Rep. Mary Caferro, D-Helena, and Sen. Christopher Pope, D-Bozeman, both asked DPHHS Director Charlie Brereton to consider a pause to allow for eligible residents who were removed to get reenrolled faster. 

Brereton responded in no uncertain terms. 

"I will not be pausing the redetermination process," he told committee members multiple times, adding that he believes that many of the people who were removed from the federal healthcare program were disenrolled "correctly."

Montana is not alone in its overhaul of the Medicaid system — this process is happening nationwide. While the federal government’s public health emergency was in effect for the COVID-19 pandemic, people previously approved for coverage stayed on Medicaid whether or not they no longer qualified under certain metrics. With the end of the official public health emergency, states started to reconfirm residents’ eligibility for the program, which has led to droves of people being removed across the country. Montana started the process in April and it's set to last 10 months.

"[The Centers for Medicare and Medicaid Services] has allowed states to pause the redetermination process in order to address both backlogs and ensure that states are properly reaching enrollees with information," said said Heather O'Loughlin, executive director of the Montana Budget and Policy Center.

Despite the pleas from the only two Democrats on the Health and Human Services Interim Budget Committee, some numbers provided by DPHHS show that the initiative is winding down and operations may be improving. That is to be expected, however, because the department has consistently said that it began reassessing eligibility for Medicaid with people who were likely to no longer be eligible.

According to numbers from DPHHS presented at the meeting, the redetermination process has started for more than 90% of the 320,000 people who were originally covered in April. The majority of people who are removed from the federal healthcare program in Montana are disenrolled for procedural reasons like not receiving or filling out renewal paperwork. 

Pope was not satisfied with those updates.

"There’s still a major fire on deck as far as I can tell," Pope said. "If there were 300 people … that would be too many people," Pope later said of those who are still eligible despite being kicked off the program for procedural reasons. 

This meeting is the first time the Gallatin County senator has requested a pause in the process.  

"If they get sick today, they have no coverage. It's going to bankrupt families and it creates chaos and a lot of anxiety," Pope told the Montana State News Bureau. "It just needs to be fixed and fast."

DPHHS did not immediately respond when asked for more information on why Brereton is not willing to instate a pause.

“DPHHS is committed to ensuring that only Montanans eligible for taxpayer-funded health care maintain their Medicaid coverage, and transitioning those no longer eligible due to employment or other factors to alternative coverage options,” DPHHS Communications Director Jon Ebelt previously told the Montana State News Bureau. 

The department also provided the interim committee new numbers on the call center operations: staff said the wait times decreased 13% from September to October and call abandonment rates decreased 23% over the same time span. Call wait times in Montana have been particularly severe compared to other states. 

In an August letter from the federal government addressed to Montana’s Medicaid Director Mike Randol, the Centers for Medicare and Medicaid Services (CMS) raised concerns about how the state's redetermination process was going, citing concerns about a call abandonment rate of 40%.

“Based on your state’s data, CMS has concerns that your average call center wait time and abandonment rate are impeding equitable access to assistance and the ability for people to apply for or renew Medicaid and CHIP coverage by phone and may indicate potential non-compliance with federal requirements,” the letter read.

Fifteen other states also received a similar letter from the federal government.

Medicaid is likely to be one of the main issues at the state's next legislative session in 2025 not only because of the unwinding process but also because Medicaid expansion is set to expire in June of that same year. Montana expanded Medicaid under Obamacare in 2015 and has renewed the expanded program once since then.

Montana Budget & Policy Center

Shaping policy for a stronger Montana.

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.