Medicaid Montana Eligibility 2023: Around 7,900 Residents May Lose Coverage, But ‘Redetermination’ Process Now Ongoing

By Telita Montales , Parent Herald May 27, 04:11 am

The process of "redetermining" Montana citizens' eligibility for Medicaid has begun, and by the end of the month, roughly 7,900 people may no longer be covered, according to NY Times.

Concerns regarding the possible influence on healthcare access and the financial load on healthcare systems are raised by this considerable number.

According to Daily Montanan, a change in the law passed in 2021 and the expiration of COVID-19 pandemic rules that allowed for continuous eligibility have prompted the redetermination process. Previously, Montana had been one of two states providing "continuous eligibility," meaning that qualifying individuals received Medicaid coverage for a continuous 12-month period, even if their circumstances changed during that time.

Advocates argued that this approach helped address the fluctuating life circumstances of Medicaid recipients. However, lawmakers from the Republican majority contended that the change was necessary to ensure coverage only for those who genuinely qualified, with the aim of saving taxpayer money.

Concerns Arise Over Potential Coverage Loss as 43% of Cases Remain Unresponsive

The pandemic temporarily halted the implementation of the new law, as continuous eligibility was maintained under pandemic measures. However, the change is now being put into effect as a result of those measures' recent expiration. The issue is that some Medicaid beneficiaries may not be aware of the updated specifications and the obligation to submit the required documentation for redetermination.

Currently, 7,900 people, or around 43% of the 18,370 instances, have not replied to the redetermination procedure and are in danger of losing their Medicaid coverage.

Health leaders anticipate that part of the decrease in coverage may be natural due to the pandemic's end and the reset of eligibility criteria. Nevertheless, there is apprehension that individuals may unintentionally lose coverage due to a lack of awareness.

Olivia Riutta, the director of special populations for Cover Montana, an organization that helps residents navigate the Medicaid qualification process, emphasizes the importance of providing residents with accurate information. Riutta stresses that the process requires individual attention and urges those affected to stay informed and respond promptly to any changes or paperwork from the state.

Outreach Efforts Aim To Inform Medicaid Recipients about Redetermination Process

The redetermination procedure is being made known to Medicaid users via outreach efforts. In its outreach efforts, the Montana Department of Public Health and Human Services has texted people to ask them to update their contact information. Informational materials have also been sent to Medicaid recipients, guiding them through the necessary steps.

While it is too early to determine the full impact of the redetermination process on healthcare coverage in Montana, there is heightened call volume and a noticeable increase in renewals. The consequences of churn, including administrative costs and potential rises in uncompensated care, may take time to manifest fully. Monitoring uncompensated care will be crucial in assessing whether individuals who may qualify for coverage have lost it.

Both Riutta and department spokesman Jon Ebelt highlight the importance of the ongoing efforts to inform Medicaid recipients about the changes. They encourage residents to seek assistance if needed, as navigators are available to provide guidance.

It may take up to a year to gather reliable statewide data on the effects of the redetermination process and churn on the healthcare system.As the redetermination process continues, Montana aims to strike a balance between ensuring eligibility compliance and preventing coverage loss for those who genuinely need it.