Two studies conclude Medicaid expansion in Montana has been extremely successful

Charity care plummets as nearly 1-in-10 Montanans are now covered

Protestors carry signs as they demonstrate against proposed cuts to Medical and Medicare outside San Francisco city hall on Sept. 21, 2011. (Photo by Justin Sullivan/Getty Images)

It’s not a surprise to the Montana Healthcare Foundation or the Headwaters Foundation that Medicaid expansion has been successful. Still, experts say they’re surprised at how many different aspects of healthcare have been positively impacted in this very rural state.

Two studies released this week examine the effects Medicaid expansion, first passed in 2015, have had on the state. One study, commissioned by the Montana Healthcare Foundation, was conducted by Manatt Health. The other study was co-sponsored by the foundation and Headwaters Foundation. Both used 2019 data, the most recent available.

Both show overwhelmingly positive impacts, including more Montanans having health insurance and stabilization of rural hospitals. But the positive effects went much deeper than just covering more people or reimbursing hospitals. The details of both reports show a huge uptick in accessing mental health, and corresponding growth in mental health options. The reports also showed a similar uptick in the number of people seeking treatment for substance abuse, and growth in that area of healthcare, too.

One of the highlights of the report prepared by Manatt said that 30,000 expansion enrollees used the mental health coverage. And when COVID-19 hit and many providers stopped seeing patients in person, Montana was quick to react, changing the guidelines to allow telehealth visits, which helped patients as well as providers. Telehealth visits increased 1,400 percent.

The findings, which were touted by both the Montana Healthcare Foundation and Headwaters Foundation, also helped establish a trendline from past surveys that were similar. The data was a rebuttal of the fears of some legislators, who were concerned initially about adopting the Medicaid expansion, chiefly that people would stay on the state-supported healthcare for too long, choosing to reap the benefits without looking for employment.

However, the joint study by the foundation and Headwaters showed that the number of Montanans with low incomes who jointed the workforce increased by 2 percent. Montana Healthcare Foundation Chief Executive Dr. Aaron Wernham said that may be because Montana was able to modify its program to create a workforce component through HELP-Link. HELP-Link is a voluntary employment assistance program that connects as many as 9,000 expansion enrollees to workforce training and local job openings. It also helps employees step up to a different, better job opportunity, Wernham said.

Initially, lawmakers were worried that expanding Medicaid would provide a disincentive to work, but the opposite was found. And the studies reported that the average Medicaid recipient spends less than two years on the program — not indefinitely as some had worried.

“This is a reflection that people want and need help, but they also want jobs, and this helps balance that,” said Headwaters Chief Executive Brenda Solorzano.

Montana Healthcare Foundation reports that nearly 60 percent of Montana businesses have one employee enrolled in Medicaid expansion and nearly one in four businesses have at least 25 percent of their employees enrolled.

Wernham said there are other stories of the expansion helping that may be individual anecdotes but illustrate the program’s success. For example, a construction worker who injured his ACL didn’t have insurance for a surgery, but couldn’t work until he got it repaired. Because of Medicaid expansion, he had the surgery and was able to return to the workforce.

The reports found that Medicaid expansion added $650 million to the economy, which study authors say contributes 6,000 new jobs and $400 million in personal income.

“Our perspective is that we believe it’s important for policy makers to have good, unbiased data and make good decisions,” Solorzano said. “It’s important to understand that the expansion has been healthy for our state.”

The expansion also cut in half the number of uninsured residents, meaning that hospitals and clinics were not sustaining large losses from charity care. In 2019, 69,000 Montanans went to wellness exams and most got vaccines or screenings.

Wernham pointed out that nearly 5,000 colonoscopy exams were performed and approximately 1,000 of those detected and removed cancerous lesions or polyps.

Among the largest group enrolling in the program was American Indians. Of the 50,000 who are now enrolled in Medicaid, 15,000 came through the expansion, which has helped tribal members gain access to more medical services and preventative measures.

“I think the expansion has outperformed our expectations,” Wernham said.