Medicaid in Montana: Preventative health, mental health on the rise, rural hospitals remain open

By: - February 9, 2023 6:57 pm

The cover of the Montana Healthcare Foundation’s 2023 report, “Medicaid in Montana.” (Cover courtesy of the Montana Healthcare Foundation).

It’s hard to find a state that has made Medicaid expansion more successful than Montana, two new reports released Thursday suggest.

Headwaters Foundation and the Montana Healthcare Foundation updated two annual reports that show nearly 80 cents on every dollar of Medicaid spending comes from the federal government, and that means that nearly 300,000 Montanans have health insurance, including more than a third who would likely be uninsured today if expansion hadn’t happened.

That translates to 7,500 more jobs that have been created and at least $250 million of income that residents could spend elsewhere in Montana’s economy.

The two reports released were “Medicaid in Montana: How Medicaid Impacts Montana’s State Budget, Economy, and Health;” and, “Economic Effects of Medicaid Expansion in Montana.”

Because these same reports have been updated yearly, Montana is among the leaders in documenting how Medicaid has changed the state’s healthcare complexion, and the latest data suggest that after residents enroll in Medicaid, spending on emergency room or hospital visits increase initially, but then rapidly switch to lower-cost preventative measures or treatments through pharmacy. That suggests expanding the service has helped Montanans manage chronic health problems in a more cost efficient way with likely better outcomes.

“Remember that Medicaid expansion was meant to improve access to preventative health, lower costs and increase the health of low-income Montanans,” said one of the report’s authors, Kevin McAvey of Manatt Health, the company that gathers the data and produces the report.  “This shows earlier diagnoses meant earlier treatment.”

The report also highlighted the expanding use of mental health services, largely boosted by the quick conversion to telehealth spurred on by the COVID-19 pandemic shutdown. The reports show that not only has Montanans’ usage of mental health services increased, but so, too, have the number of providers, meaning more residents have choices.

Bryce Ward, an economist who was hired by Headwaters Foundation, has been studying the economic impacts since the state expanded Medicaid. He said the program has done five things:

  • Increase coverage – by nearly 100,000 residents,
  • Increase utilization of the healthcare system,
  • Added to the disposable income low-income residents have,
  • Created 7,500 jobs, and
  • Infused the healthcare economy with nearly $1 billion.

State funding has been modest, while the federal percentage has increased at a higher rate.

The reports highlighted that more than half of the people who enrolled in the expansion said they had previously skipped healthcare or avoided treatment of chronic conditions because they couldn’t afford it. That led to more emergency department visits, hospitalizations and care that wasn’t reimbursed. Those trends have all been reversed.

Ward said a more robust national literature is beginning to show other benefits, and Montana seems to be falling into line with the nationwide trends. Those include credit scores of Medicaid recipients increasing; increasing child support; a reduction in criminal offenses; longer life spans and a decrease in bankruptcy.

The reports also challenged some of the long-held concerns that lawmakers had about expanding Medicaid in Montana. For example, the experts said this is the first year where long-term data can be analyzed, but it shows that in the previous four years, more than 100,000 Montanans enrolled.

However, they did not stay on the program long, in many cases. Seventy-one percent of new enrollees worked full-time while receiving the help, suggesting that many were low-income Medicaid users and simply couldn’t afford healthcare costs.

Ward pointed out that 50% of Medicaid recipients work in just 20 occupations, which include home care, child care, cooking and the service industry. He said those who don’t work tend to be single people, those with disabilities, those who are going to school, or those who can’t afford childcare.

Ward and others also pointed out that the state’s Medicaid program had a lot of churn, helping to dispel the notion that once people start on the program, they’ll never leave. Instead, Ward’s research found that during the course of four years, 25% of adults spent less than one year on the program. Only one-third remained on it for four years, with others moving in and out of the program, likely as job or life circumstances changed.

“So really, there’s a larger percentage of Montanans benefiting from this,” Ward said.

Rural importance

This year’s report also demonstrated how important the program is to rural Montana. More than two-thirds of enrollees are in rural areas. Sixty-four percent of Montana’s population is consider rural, which means usage rates are nearly identical for urban or rural residents.

Furthermore, since the Medicaid expansion, no critical access hospitals have closed, and uncompensated care – for those without insurance or the means to pay – has declined by 35% between 2016 and 2021.

Prevention is cheaper

As the reports tracked that the cost of caring for people on the program usually begins to decrease over time, they also shows that more people participated in wellness and disease screenings, which often led to earlier diagnoses and more cost-effective treatments.

For example, cholesterol screenings increased by 20% from 2019 to 2021, while wellness exams rose 14% and breast cancer screenings shot up by 27%.

Those numbers translated into large successes for the state as 81 new cases of breast cancer were detected from the Medicaid screenings in 2021, and nearly 1,000 cases of colon cancer were averted by the screenings.

Treatment for other chronic conditions likes hypertension and diabetes rose, and more than 34,000 people received mental health treatment while 5,750 received substance abuse treatment.

For people with chronic conditions, their use of the emergency room also rapidly fell. Medicaid residents in Montana who have diabetes saw their emergency department visits drop by 4%, while mental health emergencies decreased by 9% and substance use disorder declined 11%.

The reports also point to the increase in Montanans needing mental health or substance-use treatment.

“Medicaid funding for substance use disorder treatment services has increased by a factor of five since the implementation of Medicaid expansion, increasing from $5.1 million in 2016 to more than $24 million in 2021,” the report said.

The number of state-approved providers for substance abuse treatment rose from 95 to 208 in that same time period.

Telehealth on the rise

Montana continued to utilize telehealth as the COVID-19 pandemic started. For example, mental health consultations shot up to 53% being done online. And even through December 2021, that number hovered around 20%. Prior to February 2020, telehealth visits were at 3% according to the reports.

Even other physical telehealth visits reached a peak of 5% in April 2020, but have since fallen to 1%, pre-pandemic levels.

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Darrell Ehrlick
Darrell Ehrlick

Darrell Ehrlick is the editor-in-chief of the Daily Montanan, after leading his native state’s largest paper, The Billings Gazette. He is an award-winning journalist, author, historian and teacher, whose career has taken him to North Dakota, Minnesota, Wisconsin, Utah, and Wyoming.