Democrats oppose changes to Medicaid expansion eligibility

HELENA (AP) — Democratic lawmakers in Montana said they are opposed to a plan to end 12-month continuous eligibility for people who qualify for Medicaid expansion or another program that provides health coverage for those with a disabling mental illness.

The Department of Public Health and Human Services is seeking federal permission to eliminate the continuous eligibility provision for Medicaid expansion at the direction of the Legislature, the agency said in a draft application to the Centers for Medicare and Medicaid Services.

It is seeking the same change for the mental health program because it would reduce the administrative burden to have consistent eligibility requirements, said Darci Wiebe, the administrator of the health department's Health Resources Division.

About 100,000 Montanans are covered under the Medicaid expansion program that provides health insurance for people who are not eligible for traditional Medicaid coverage, but do not qualify for federal subsidies on policies sold under the Affordable Care Act.

Republican lawmakers reduced the state's Medicaid expansion appropriation and included a statement in the budget bill saying: "The Legislature intends that the Department of Public Health and Human Services eliminate the policy of 12-month continuous eligibility for the Medicaid expansion population."

However, other efforts to pass a standalone bill to end the 12-month eligibility policy failed during the 2021 Legislature, Democrats noted.

"The legislative intent in my view is ambiguous at best and again, DPHHS can do this if they wish, but I don't think they can put it on the backs of the Legislature," Democratic Rep. Ed Stafman of Bozeman said Tuesday. "That is what they claim several times in the petition."

The Children, Families, Health and Human Services Committee discussed the proposals, which must be approved by the federal Centers for Medicare and Medicaid Services. The Medicaid expansion proposal has been the subject of two public hearings. Public comment is being taken through the end of August. Committee members said they plan to include their individual comments on the proposal.

Under Montana's current Medicaid expansion program, people remain eligible for coverage for a full year, even if their income increases and they no longer meet the financial requirements. Republicans want to be able to move people off the program when they are no longer financially eligible, rather than wait for the end of that 12-month term, arguing it would save the state money.

Opponents counter it will cycle people on and off the program and disrupt continuous care for those with chronic conditions, such as high blood pressure or diabetes, and will lead to higher medical costs through the use of emergency rooms rather than primary care providers.

"The department's proposal represents a threat to the health care of thousands of Montanans," Stafman, chair of the committee, said in a statement. "It makes zero sense to take an effective program and make it less efficient, less fair, and more bureaucratic. If the department moves forward with this misguided proposal, they will damage Montanans' health and hurt the bottom lines of businesses that rely on Medicaid to cover their employees."

Opponents to ending continuous Medicaid eligibility for people suffering with severe disabling mental illness argued the Legislature did not request changes for that program, which covers about 1,000 people.

There are already fraud and abuse measures within the Medicaid system, said Kristin Page-Nei, whose brother is covered under the program. "We do not need another layer of red tape putting up another barrier."

Separately, the waiver application notes Montana expects a pending August 2019 Medicaid expansion application that sought to add work requirements and increase premiums for some will be rejected by the Centers for Medicare and Medicaid Services. The Biden Administration has overturned work requirements in several states whose programs were approved under the Trump Administration.

"This is not the time to experiment or test policies that risk a substantial loss of health coverage or benefits, especially for individuals and communities significantly impacted by COVID-19 and other health inequities," CMS said in a February statement.

No one can lose Medicaid expansion coverage during the public health emergency caused by the coronavirus, which is expected to last at least through the end of the year.