Montana children suffer amid Medicaid unwinding

Watching a child battle cancer is incredibly hard, but watching a child forgo cancer treatment because he lost insurance coverage is devastating. This is the reality that some Montana families are facing.

Although that this may seem like the worst-case scenario, the stories are endless. Kids are missing speech therapy that will impact their ability to communicate with the world. Families are scaling back on asthma and diabetes medication and are ending up in the hospital. One of our patients’ parents with a high-risk pregnancy waited weeks to find out if she could have a potentially life-saving surgery.

So why this is happening?

During the Covid-19 pandemic, everyone with Medicaid insurance, including children with Healthy Montana Kids (HMK), stayed covered. This spring, states were given the green light to begin redetermining Medicaid eligibility, and in April, Montana started with a 10-month process. That means that the Montana Department of Health and Human Services (DPHHS) must redetermine eligibility for nearly 325,000 Montanans on Medicaid – including those who are blind, disabled, pregnant, seniors (including many in nursing homes), working parents and children.

Montana has never attempted to redetermine eligibility for so many people so quickly. It is a huge undertaking, and unfortunately, it isn’t working well. Since this process began in April, over 55,000 Montanans have lost their coverage. Of these, 24,000 are children. It’s heartbreaking, and particularly frustrating because the majority of people who have lost coverage are likely still eligible. The process to renew coverage is time-consuming and difficult to navigate, and the system is overburdened.

Some parents only discover their child’s coverage has lapsed when they are checking in for a doctor’s visit and are told they no longer have insurance. Others find out at the pharmacy, when suddenly their child’s medication is astronomically expensive. Most of these families are not able to pay hundreds of dollars out-of-pocket. Families can be forced to choose between receiving medical care for their child, picking up potentially life-saving medication, and paying their bills. This is an impossible position to put families in, and is unacceptable.

Montana Medicaid is critical in ensuring our children grow up healthy. This coverage allows children to attend annual check-ups, receive necessary immunizations and recommended screenings. It also ensures children can receive appropriate care for acute illnesses and injuries. When people do not have access to care, they are more likely to forgo care. This can lead to delayed diagnoses, more severe presentations when families finally do present for care, and overall worsened health outcomes. This is a significant public health issue – and it’s avoidable.

Montana has the option to take a 30-day pause to catch up on backlogged paperwork and extend the time people have to return their information. People shouldn’t lose their health insurance coverage because the state is short-staffed.

People in our state are hurting and scared. We must do better.

If you or someone you know is in Montana’s Medicaid program, ensure your address is updated with DPHHS. You can verify your address by clicking here. Second, watch your mail closely – that is how DPHHS will contact you. Third, return any forms mailed to you as quickly as possible!

If you missed your renewal window, do not panic. Fill out a new application and ask for up to 90 days of retroactive coverage. You can apply online at apply.mt.gov.

It’s also important to remember that each Medicaid program has different rules about income. Even if you as a parent don’t qualify, your child may still qualify.

Be persistent in contacting the Montana DPHHS at 1-800-362-8312. The wait time is slowly decreasing, and they can answer questions about your case and provide real-time assistance. You can also contact Cover Montana, a nonprofit helping with health coverage, at www.covermt.org.

On behalf of the Montana Chapter of the American Academy of Pediatrics and our 150 members, please know we are here to help. If you have any questions, do not hesitate to talk with your child’s pediatrician.

Together, we can improve the “unwinding” process and protect the health of Montana children and families.

The Executive Committee of the Montana Chapter of the American Academy of Pediatrics: Dr. Lauren Wilson, Missoula; Dr. Teresa Blaskovich, Billings; Dr. Atty Moriarty, Missoula; Dr. John Cole, Kalispell; Dr. Jordan Lejeune, Great Falls; Erin Green, DO, Helena; Shaina Rogers, DO, Bozeman; Dr. Katy Lysinger, Billings; Ericca Berry, PNP, Glendive; Dr. Patricia Notario, Billings; Dr. Elizabeth Beil, Missoula.