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Montana data shows 44% who lost coverage in Medicaid unwinding were kids

by BLAIR MILLER Daily Montanan
| October 10, 2023 12:00 AM

Nearly half of the roughly 55,000 Montanans who lost Medicaid coverage through the disenrollment process between April and August were children, according to new data provided to a legislative committee by the Department of Public Health and Human Services.

In response to questions from the Health and Human Services Interim Budget Committee, DPHHS provided a dataset showing how many children lost coverage in the ongoing disenrollment process, where they lived, and a breakdown of the number of people in different age groups that lost coverage.

The department also answered questions from lawmakers about what strategies offered by the federal government it has utilized to minimize the number of people losing coverage.

The disenrollment data covers the number of people who lost coverage between April and August, and was pulled on Aug. 25, according to the department, which noted the numbers will change as more people go through the process.

It shows that 24,150 of the approximately 55,000 people who lost coverage over that period – about 44% – were children ages 18 and under. The large majority of those children were between the ages of 6 and 18. But 3,142 of them were ages 1 to 5, and 20 were infants under a year old. Another 3,596 Montanans ages 19 and 20 lost coverage.

About 18% of the entire population that lost coverage over that time period were Native American, according to the data. According to the latest U.S. Census Bureau data, only 6.5% of Montanans identify only as Native American.

Slightly more women (28,549) lost coverage during the first four months of disenrollment than men (26,355), according to the data. Around 54% of the number of people who lost coverage were ages 21 to 64; DPHHS does not break that number down further in its dataset.

The data shows that the number of children per county who lost coverage generally coincides with a county’s population, meaning more children lost coverage in the state’s largest counties, like Yellowstone, Gallatin, Missoula and Flathead counties.

But it also shows some outsized losses in certain counties. Glacier County, population 13,681, saw 802 children lose coverage in those initial months. That’s in comparison to the 887 who lost coverage in Ravalli County, population 47,298. About 33% of Glacier County residents are age 19 and under, compared to 20% of Ravalli County residents, according to U.S. Census Bureau data.

In Big Horn County, 702 children lost coverage out of a county population of 12,851. About 35% of Big Horn County residents are age 19 and under. In Roosevelt County, 528 children lost coverage out of a total county population of 10,572, about 36% of which are under age 19.

Glacier, Big Horn and Roosevelt counties are all spanned by Native American reservations – the Blackfeet Reservation, Northern Cheyenne and Crow reservations, and the Fort Peck reservation, respectively.

Nearly 4,000 kids in Yellowstone County lost coverage, along with 2,579 in Flathead County, 2,000 in Gallatin County, 1,885 in Missoula County, and 1,623 in Cascade County.

KFF Health News, which is tracking the Medicaid unwinding nationwide, estimates that in 17 states reporting ages, about 40% of people disenrolled have been children nationwide.

Montana’s Democratic House and Senate leadership called the new data “incredibly disturbing” and blamed Republican Gov. Greg Gianforte’s administration. They had called on the governor to pause the redeterminations and come up with a better process in July.

“Montana kids deserve to grow up happy and healthy, but Governor Gianforte’s mismanagement of Medicaid is denying them an opportunity,” House Minority Leader Kim Abbott, D-Helena, and Senate Minority Leader Pat Flowers, D-Belgrade, said in a joint statement. “We have urged the governor time and time again to reverse course. It’s long past time that he listen, and do right by Montana’s children and their families.”

The most recent data from DPHHS shows that from April through July, 49% of nearly 150,000 people who went through the redetermination process had their coverage closed. About one-third of people had their coverage renewed.

Nearly 63% who had their coverage closed failed to fully provide the requested information, while 30% were deemed to be ineligible, according to DPHHS.

Another 38,415 people are currently having their eligibility reviewed from the August group, and 24% have had their coverage renewed already. The rest of the group is either having their eligibility processed or awaiting processing.

DPHHS expects the number of people needing to go through the redetermination process to decrease each month through the end of the period in January.

In August, the deputy director for the Centers for Medicare and Medicaid Services (CMS) wrote a letter to Montana State Medicaid Director Mike Randol warning that CMS was concerned about call center wait times averaging 42 minutes in May, and a 40% call abandonment rate, and how those affected people’s ability to renew their coverage – saying the state was potentially noncompliant with federal requirements. That letter also raised concerns about Montana’s procedural termination rate.

“This high percent raises concerns that eligible individuals, including children, may be losing coverage,” the letter said. “… While CMS expects procedural terminations, a high rate of procedural terminations may indicate that beneficiaries may not be receiving notices, are unable to understand them, or are unable to submit their renewal through the required modalities.”

The letter urged Montana to “take further action” to reduce the number of procedural terminations and suggested the state implement more of the 23 strategies CMS offered to states to try to minimize them.

A CMS website that details how many of those strategies, implemented through a type of waiver, each state is using notes that Montana is using two, though the site appears to have last been updated in August.

But in another response to the interim budget committee, DPHHS said it was using 10 of the strategies. The department said it was not using seven of them, and six “are not applicable to Montana.”

DPHHS said it was renewing eligibility based on financial findings for other benefit programs, renewing eligibility for people with no income and who are at or below the federal poverty level, and utilizing other waivers to try to streamline the process for certain groups.

A spokesperson for DPHHS said he could respond to further questions posed Friday morning about the strategies being used or about any efforts to cut down on the number of children losing coverage until Tuesday after Monday’s holiday.

KFF Health News says 7.8 million Americans have been disenrolled from Medicaid as of Oct. 2, and about 13.3 million have had their coverage renewed.

KFF Health News says nationwide, 73% have lost their coverage for various procedural reasons, with Montana sitting about in the middle of the pack.

Blair Miller is a Helena-based reporter. The Daily Montanan is a nonprofit newsroom. To read the article as originally published, click here.