Report: Change in Montana law could mean more than 20,000 lose health care

GWU authors said state miscalculated and underestimated impacts of Senate Bill 100

Sen. Cary Smith, R-Billings, speaks in favor of Senate Bill 101, which would establish guidelines for direct provider care. (Montana Public Affairs Network)

Two of the country’s leading public health experts are weighing in on the Montana Legislature’s plan to limit Medicaid’s “continuous eligibility,” saying that calculations, estimates and numbers being given to the public are flawed and miscalculated, which will lead to as many as six times the number of people being kicked off the insurance rolls than lawmakers have said.

An analysis by George Washington University’s Department of Health Policy and Management, released a seven-page report on Thursday which calls into question the Montana Department of Health and Human Service’s assumptions and the fiscal note attached to Senate Bill 100.GWU report SB100

Senate Bill 100, which is being carried by Sen. Cary Smith, R-Billings, passed the Senate and now awaits action in the state House. One of the provisions of the measure would eliminate Medicaid’s “continuous eligibility.” Montana is one of two states that allows continuous eligibility, which means that once a person or child is enrolled in the program, they have coverage for a full 12-month period without needing to reverify.

SB100 would change that and allow the state to be in a constant state of checking and reverifying Medicaid recipients. Proponents of Smith’s bill argue this ensures that benefits are only going to those who need the public assistance, while opponents say the change would add to the administrative burden and kick enrollees off the program if their income varies slightly, and cause them to reapply as it fluctuates, adding to “churn.”

The experts argue that the state misrepresented the amount of money it would save, underrepresented the number of people who would lose healthcare coverage, create more expensive medical emergencies, and used flawed calculations to make the effects of the bill seem not so severe.

Calls or requests to the bill’s sponsor, Sen. Smith, went unanswered Friday, as did a request for comment from the state budget director’s office.

A copy of the report was also forwarded to the Department of Health and Human Services for review and possible comment, but as of Friday afternoon, none of those departments had commented on the findings.

Miscalculation

The authors of the report, Drs. Leighton Ku and Erin Brantley, said that Senate Bill 100 and the termination of continuous eligibility “will lead to gaps in coverage for a far larger number of people.”

Ku and Brantley said the estimates that were presented by Smith and the department underrepresented the number of people who would lose coverage in Montana by a factor of six times.

“We estimate that about 22,000 Medicaid and CHIP beneficiaries would be harmed by the loss of 12-month continuous eligibility policies each year,” they wrote.

The authors also pointed out that gaps in coverage, especially when dealing with chronic medical conditions, could lead to more expensive care in the future, while also putting some lives in jeopardy without access to medical care.

Ku and Brantley said that research shows that average condition of patients with continuous coverage tends to be better because the access to health care means more prevention.

“Children with more serious health care needs were more likely to have received medical care, preventive health visits or specialist care in states with continuous eligibility,” the report said. “As people have stabler enrollment in Medicaid, their monthly health care costs decline.”

They pointed out that in other states which have adopted rolling verification that many people were thrown off healthcare because of administrative problems, not because they were ineligible. Ku and Brantley gave documentation from Texas to help illustrate their concerns with Montana’s proposed legislation.

“When automated data checks were implemented in Texas’ Medicaid program, about 4,000 children lost Medicaid coverage each month. Most children lost coverage not because they were confirmed to be no longer eligible but because of paperwork issues. Over half the children regained coverage in the next year, suggesting that they were actually eligible the whole time, they just lost coverage due to paperwork burdens,” the report said.

The George Washington study also found that Ohio had underestimated the cost of implementing an automated check system while overestimating the amount of savings.

Savings overstated

The report also notes another portion of the bill which estimated a cost savings to the state in Fiscal Year 2022. The authors note that during emergency COVID-19 relief legislation, supported by Sens. Jon Tester, Steve Daines and then Rep. Greg Gianforte, made continuous enrollment and additional funding from the federal government mandatory through Dec. 31, 2021. Because of that, Montana will not be able to implement Senate Bill 100 until after that point without violating federal law.

Therefore, Ku and Brantley argue, the public and other lawmakers may be supporting the legislation based on savings that legally cannot happen.

The authors also pointed out that making changes to the Supplemental Nutrition Assistance Program, often called “food stamps,” won’t save Montana any money, but could result in the state spending more.

The report said that SNAP’s funding comes entirely from the federal government, but implementing a program to check participants’ eligibility will come from state funding.

“(That) will mean that there are higher administrative costs and that less federal funding will come to Montana, reducing revenue that flows to Montana’s grocery stores and food producers,” the report said.

Deepening disparities

Finally, the report took issue with putting more burdens on enrolling in insurance or assistance programs, like Medicaid and SNAP. The researchers questioned whether the administrative changes, which will include more eligibility checks, paperwork and software, has the potential to disenfranchise those already struggling.

Ku and Brantley note that often the people who are eligible for the programs lack connections and technology that would help them during the verification process. More paperwork and more administrative hoops to jump through will be an impediment, affecting largely poor and minority groups, they said.

The report raised concerns that Native Americans and those in rural areas will lack internet connections and could lose eligibility because of difficulty completing paperwork and access.

“This is not the time to impose new barriers that keep needy Montanans from getting health care,” the report concludes.