People who lost Medicaid urged to look at full scope of options

Tim Noonan grabs a number to head inside to wait for his turn at the Office of Public Assistance in Kalispell. He’s a mental health worker at Logan Health and he’s there to work on restoring Medicaid coverage for two of his young patients.

“That's why I'm showing up here, because I tried a long phone call twice on Friday. And both times I was on the phone, probably like 40 minutes each, trying to get through and talk to someone,” Noonan said.

Noonan’s patients are among the more than 112,000 people in Montana who have lost Medicaid since April of 2023,  according to the Montana Department for Public Health and Human Services.

The process to see if someone is still eligible for their Medicaid coverage happens periodically. However, states were not able to engage in redetermination over the course of the pandemic due to the Families First Coronavirus Response Act, which required that Medicaid programs keep people continuously enrolled through the end of the Covid-19 pandemic in exchange for enhanced federal funding, as reported by the Kaiser Family Foundation. The Consolidated Appropriations Act ended continuous enrollment last March, which allowed states to begin Medicaid redetermination, also known as Medicaid unwinding.

A large number of those affected are children. In December, a letter addressed to Montana Gov. Greg Gianforte from U.S. Secretary for Health and Human Services Xavier Beccerra stated he was alarmed that more than 24,000 children in Montana were unenrolled from Medicaid or the Children's Health Insurance Plan, also known as CHIP, by September of 2023. 

Insurance assisters in the Flathead Valley say options are out there for those who lost their Medicaid, particularly for children. 

Greater Valley Health Center Certified Application Counselor Lori Jones helps people apply for coverage with Medicaid and through the Marketplace found at healthcare.gov, during an annual period where individuals and families can shop for health insurance. Also known as insurance assisters or navigators, she and her coworker are typically busiest during open enrollment, but 2023 was a little different. 

“With the Medicaid unwinding, it's been very, very busy — that started in April,” Jones said. “Marketplace is also an assistance program for folks to get help paying for an insurance policy, filling out an application will decipher if the entire family or part of the family qualifies for Medicaid … It's been really busy with all of the folks transferring from Medicaid to Marketplace,” 

Jones said because children have higher eligibility for Medicaid, this process allows families to restore coverage for their children even if the adults in the household no longer qualify. She said many don’t realize there’s different Medicaid programs and that eligibility varies, giving the example of how pregnant women have a large threshold to qualify for Medicaid. 

“And if you’re a woman who is not pregnant, there's the Plan First Program, which covers wellness, like your Pap smear, birth control and any family planning appointments that a woman has. That covers people over 200% of the poverty level, compared to the regular adult Medicaid which is 138%,” Jones said. 

For those who’ve lost coverage and no longer apply, Jones said there is a special enrollment period offered to them. 

“Open enrollment for marketplace is once a year, but if someone has a special circumstance like losing Medicaid, if they change jobs or if they have a new family member, or if there's a divorce — there's different circumstances for special enrollment periods,” Jones said. 

The state health department said 72,000 people lost coverage due to failure to provide requested information. Jones said she feels like it’s been tough for younger adults who have not had to engage with Medicaid reaching out for several years. 

“They were in the home as a 16 or 17-year-old, or 18 to 19-year-old, and then were out on their own for those three years — they didn't even realize how that process worked. So, I think it's been an eye-opener for that age bracket,” Jones said. 

Olivia Riutta is the Population Health Manager for the Montana Primary Care Association, which received a federal grant in 2021 that continued to fund their insurance navigator services for Medicaid. 

She said their team of navigators also help people apply for coverage through Marketplace, which offers affordable options for low income individuals. 

“Healthcare.gov is a place where you can put in information about yourself and your family, where you can apply for tax credits to make your plan more affordable. And you can go shopping with those tax credits and select the plan that makes the most sense for your monthly budget,” Riutta said. 

Shopping for the best plan includes making sure preferred health care providers are covered, Riutta added. In Montana, Marketplace shoppers choose between plans offered by Blue Cross Blue Shield, PacificSource and Mountain Health Co-op.

She said the process allows applicants, and the navigators who assist them, ways to tailor each plan. She gave the example of someone applying for insurance that doesn’t have a lot of health needs, versus someone who might have a chronic condition that needs to see many specialists.

“You're really working with each individual to figure out what their, what their health and their financial needs are to help them find a plan that works best specifically for them,” Riutta said. 

Riutta said people can connect with a Primary Care Association navigator by going to their website covermt.org and searching by their zip code to find someone to talk to locally. There is also the option to connect with someone over the phone or by a virtual call. 

“All of our help is free, it's confidential. So, even if folks have applied in years past and they just want to see what they might qualify for, don't hesitate to reach out,” Riutta said.

OPEN ENROLLMENT ends on Jan. 16. As the clock is ticking down, Jones wants to remind people that Greater Valley Health Center offers services at a sliding fee scale discount, noting that they do not turn people away who have a medical need and cannot pay. People can access this discount for a couple of times without proof of income, but once proof of income is provided, they can continue to get access to medical services through the center.

“Our lowest sliding fee scale discount is $20 for a medical appointment, a dental appointment is $30, and then the steps that go up, you know, $50 to $65 to $80. So, a single person can make $2,000 a month and still have an $80 visit here at the health center,” Jones said. 

The center also allows patients to make payments on these charges if they need to, covering medical, dental and behavioral health services. She said Greater Valley Health Center is also part of Sykes Pharmacy, which has a federally funded prescription discount program. 

“I tell you what, we've had people in tears in our office. Because medications for conditions like diabetes or for asthma inhalers are just so expensive, even on insurance coverage. We've had a couple of people with those types of prescriptions and they were just paying hundreds of dollars, and when their providers at Greater Valley Health Center send their prescription to Sykes Pharmacy, then something that may cost $700 monthly may cost $4.80 for 90 days. It's incredible savings,” Jones said. 

Greater Valley Health Center “Downtown” is located at 1035 1st Ave. West in Suite 210 in  Kalispell, offering medical and dental services. Greater Valley Health Center “North” is located at 431 1st Ave. West in Kalispell, which provides behavioral health services. The center also has clinics located in Evergreen and Hungry Horse, and provides on-site behavioral health and medical services to many Kalispell area schools. 

She said aside from their dental services, they do not offer walk-in appointments. It’s first come, first serve for urgent care, but Jones said staff will often work to find a cancellation for a walk-in patient to get a same-day appointment, if possible.

Jones said after many people got free coverage throughout the pandemic, it’s really hard for some to adjust to making an insurance payment. The Marketplace may offer some affordable options, but many decide it’s still out of reach for their budget. 

“Some folks make the decision, ‘OK, well, I don't want to pay $150 a month or more for insurance, so I'm just gonna have to go without,’ and I hate to see someone go uninsured,” Jones said. “But there are folks that have made that decision and we just give them all of the other resources that we can at Greater Valley.” 

More information about Greater Valley Health Center can be found at greatervalleyhealth.org or by calling 406-607-4900. To learn more about the Montana Primary Care Association, go to their website at mtpca.org. 

Reporter Taylor Inman can be reached at 406-758-4433 or by emailing tinman@dailyinterlake.com.