Confederated Salish and Kootenai Tribal Health clinic in St. Ignatius


This is the second installment of a three-part series, examining the impact and future of expanded Medicaid in Montana.

Anna Whiting Sorrell, director of operations, policy and planning for CSKT Tribal Health

ST. IGNATIUS – In the past 18 months, tribal health services on the Flathead Indian Reservation have added a physical therapist and more dental care, and will soon add a new clinic and new speech therapist.

Anna Whiting Sorrell, a top health official for the Confederated Salish and Kootenai Tribes, says the changes are largely linked to Montana’s 2016 expansion of Medicaid.

Expanded Medicaid – a key part of the Affordable Care Act, or “Obamacare” – has extended government-funded coverage to some 13,000 Native American adults statewide. More than 1,000 of them are in Lake County, enabling them to get the medical care they previously couldn’t afford, Whiting Sorrell says.

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Before expanded Medicaid, the tribes’ health centers provided what care they could to some of these patients, but often didn’t get paid.

Now, Medicaid provides the coverage and pays the bills – which has greatly enabled the tribes to expand available care, to all members.

“The most important thing that expanded Medicaid has done, besides ensuring that our people get care, is it has expanded our ability to bill for the services that we provide,” said Whiting Sorrell, director of operations, policy and planning for Tribal Health on the reservation. “And any money that we bill then gets reinvested in the services that we deliver.”

Expanded Medicaid now covers 86,000 low-income adults in Montana. While the income level for eligibility tops out at $16,600 a year for a single person, three-fourths of those covered are earning less than $6,000 a year for a single person, or $8,100 for a couple.

A whopping $2 billion will be spent on Medicaid expansion during its first three-and-a-half years in Montana, from 2016-2019, and all but about $100 million is from the federal government, as part of “Obamacare.”

About 15 percent of those covered by the expansion in Montana are Native Americans. The federal government covers the entire cost of Native Americans’ care and 95 percent of other participants’ cost.

Whiting Sorrell says Native Americans in Montana have a life expectancy 20 years less than non-Indians – and that expanded Medicaid is a great opportunity to provide health care to many Indians who couldn’t get it before.

Tribal health officials across the state are working hard to get as many Native Americans as possible enrolled in Medicaid, both on and off the reservations, she says.

Whiting Sorrell says she knows many Native Americans who suffered for years from a health problem or needed diagnostic testing who simply didn’t get help because they didn’t have the money.

“Some people work really hard, every day – but we don’t always have high-paying jobs in Montana: Seasonal work, part-time work, or work in the tourist industry,” she says. “That doesn’t mean you shouldn’t have access to health care.”

Under Medicaid expansion and other ACA programs, the Confederated Salish and Kootenai Tribes’ health system has seen its budget expand. All of that money gets reinvested into the system, Whiting Sorrell says.

That tribes have added a physical therapist to the system’s staff and a speech therapist is starting in January. They’ve also expanded dental care and plan to open a new clinic at Hot Springs, on the west edge of the reservation.

Tribal health systems, however, aren’t the only providers benefiting from Medicaid expansion.

At the Flathead Community Health Center in Kalispell, which serves many low-income clients, Medicaid expansion has meant a big increase in patients who are covered.

“Before, we had three out of 10 patients covered,” says Michelle Nail-Noftsinger, a nurse practitioner at the center. “Now, we’re looking at more like seven out of 10. That’s a tremendous boon – not just for patients, but also the staff working here, and the providers attempting to do their job.”

Patients who’ve gained coverage through Medicaid are more likely to follow up on referrals, go to physical therapy or get the diagnostic testing or prescription drugs they need, she says.

More insured patients and increased federal funding under the ACA has enabled the clinic to add dental services, behavioral health, obstetrics care and other health-care staff, Nail-Noftsinger says.

But not all medical centers or hospitals have seen a boom from Medicaid expansion.

At the Mountainview Medical Center in White Sulphur Springs, the expansion did extend coverage to some customers who had no coverage, enabling the small-town hospital to bill those patients, says CEO Rob Brandt.

But a good number of area patients who had been on a private, self-insured plan were able to qualify for coverage under Medicaid expansion – and Medicaid pays the hospital at a lower rate than the private plan, he says.

“When one goes from a self-insured plan to Medicaid, that has a negative impact on us,” he told MTN News. “I would say we’re one of the few (hospitals) that the Medicaid expansion has not necessarily helped financially.”

Still, Brandt says he believes expanded Medicaid has been a plus for the state.

“It’s still very good that more Montanans get coverage, and take their health care seriously and live healthier lives,” he says. “As hospitals, we’ve all banded together to try and make Montana one of the top 10 healthiest states in the country. And one of the ways to move the needle is to make sure people have coverage.”

Part 1: Medicaid expansion: The big impact of a big part of Obamacare that’s still going strong.

Next: What are the political prospects, going forward, for Medicaid expansion in Montana?

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