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Federal letter expresses concerns about Montana's Medicaid redetermination process

Montana DPHHS
Posted at 6:07 PM, Aug 16, 2023

HELENA — As Montana continues determining whether people can remain on the state’s Medicaid program, federal authorities have expressed some concerns about how the process has gone so far for those getting their coverage reviewed.

Last week, the Centers for Medicare and Medicaid Services sent letters to state Medicaid administrators across the country. That included a letter to the Montana Department of Public Health and Human Services, in which they cited concerns about the number of Medicaid recipients removed from the program for technical reasons, as well as the wait time to get help through a call center.

During the COVID emergency, the federal government directed that everyone on a state Medicaid program could remain enrolled without having their eligibility reconfirmed. That requirement ended on April 1, so state regulators must recheck most recipients’ eligibility annually and when they report changes like getting married or divorced or having a child.

There are a number of reasons why someone might no longer be eligible for Medicaid, but leaders say one of the most common is that their income rises out of the qualifying range.

When the redetermination process began in Montana, about 324,000 residents were enrolled in the Medicaid and Healthy Montana Kids programs. As of July 13, data from DPHHS showed 71,930 individuals went through the process in April and May. 34,204 of them – 47.6% – didn’t have their coverage renewed. Of those, 8,433 – about a quarter – were determined to be ineligible, while the rest were removed because they failed to provide requested information, the department couldn’t reach them or for another reason.

Montana Medicaid Redetermination Update

Overall, about 36% of all individuals whose coverage was reviewed in those two months lost coverage for what CMS described as procedural reasons. In their letter to DPHHS, CMS leaders said that high percentage “raises concerns that eligible individuals, including children, may be losing coverage.”

DPHHS leaders say they’re going to launch a public service announcement campaign in the coming weeks to highlight the importance of returning the redetermination paperwork. That campaign will run through the rest of the redetermination process – expected to last a total of ten months.

Montana is also one of 22 states that has prioritized redetermination for people who they believe are more likely to be ineligible to remain on Medicaid. Leaders say, because of that, they expect the rate of removals to go down over time.

The CMS letter also pointed to data showing a Montanan’s average wait to connect to a call center to get help with Medicaid renewals was 42 minutes, and that an average of 40% of calls were abandoned.

CMS said the data suggested that call center issues might be “impeding equitable access to assistance and the ability for people to apply for or renew Medicaid and CHIP coverage by phone.”

DPHHS leaders told MTN the demand for the helpline has fluctuated over time, but they are evaluating staffing, scheduling and other options to address the current wait times. In addition, they said some less complex cases are being transferred to a contracted call center whose wait times are not reflected in the data from the CMS letter. They said that contracted center has average wait times of around four minutes.

“CMS sent helpful feedback to states last week,” said DPHHS communications director Jon Ebelt in a statement. “We continue to closely monitor, evaluate, and strengthen our Medicaid redetermination process with a laser focus on ensuring coverage for eligible Montanans.”

In addition, DPHHS said Montanans do not need an in-person or phone interview to apply for Medicaid or complete their redetermination packet. They encouraged them to open online accounts at apply.mt.gov.

DPHHS says anyone who has lost Medicaid coverage can reapply at any time, and they can appeal the decision if they believe the department made an error. They are also working to connect people removed from the Medicaid program with other health insurance options, including through HealthCare.gov, the federal insurance marketplace.