Federal agency sends letter of concern over equitable access to Medicaid in Montana

By: - August 14, 2023 5:39 pm

Montana Department of Public Health and Human Services (Photo by Matt Volz | Kaiser Health News).

Montana may be out of compliance with federal Medicaid rules because too many people have lost coverage and call center wait times are too long, according to a letter from the federal government to the Department of Public Health and Human Services.

Montanans waited an average 42 minutes, second only to Missouri for the longest average call-center wait time, according to letters sent to all 50 states last week from the Centers for Medicare and Medicaid Service.

Additionally, the letter said Montana reported 36% of renewals due in May “resulted in a procedural termination.”

“This high percent raises concerns that eligible individuals, including children, may be losing coverage,” the letter read. “Federal regulations at 42 CFR § 435.930(b) require the agency to continue to provide Medicaid to eligible individuals until they are found to be ineligible.”

In an email, DPHHS spokesperson Jon Ebelt said the state is working towards addressing staffing shortages but that Montanans have access online.

“We continue to closely monitor, evaluate, and strengthen our Medicaid redetermination process with a laser focus on ensuring coverage for eligible Montanans,” Ebelt said in a statement Monday.

The letter from CMS, addressed to Montana Medicaid Director Mike Randol and signed by Deputy Director of the Center for Medicaid & CHIP Services at Centers for Medicare & Medicaid Services, recommended Randol review call-center data and operations to assess changes needed to meet demand during Medicaid unwinding.

At the start of the pandemic, Congress passed legislation that required states keep patients continuously enrolled, with the perk of extra funds, but Congress ended continuous enrollment earlier this year.

Ebelt said in an email to the Daily Montanan the department is directing some of the less complex Medicaid cases to a contracted call center, whose approximate 4-minute wait times are not reflected in the CMS averages. But he said meeting the needs of each client on the phone can result in lengthy calls, another reason for long wait times.

Steps the department is taking to combat long wait times, according to Ebelt, include simplifying options and better steering callers, as well as readjusting staffing levels and making changes to callback options.

Ebelt said vacancy levels at the Office of Public Assistance are at “record lows,” but DPHHS is planning to onboard more contracted staff for support.

“The department proactively contracted for staff augmentation in 2022 and will continue to add to these teams, as well as readjust contracted staff caseloads to maximize efficiency,” Ebelt said.

Medicaid also does not require an in-person or phone interview to apply, complete a redetermination packet, or report a change in circumstances, Ebelt said, adding Montanans are encouraged to open an online account.

“Even if an individual did not return their information in time, they can still return the packet within 90 days electronically or by mailing, faxing, or dropping it off at an Office of Public Assistance and it will be treated as an application,” he said.

States are all working to end continuous enrollment, which means fewer people will get coverage, but in Montana 64% of people lost coverage due to “failing to provide requested information,” according to a state dashboard. Nearly 25% have been determined ineligible.

Ebelt said the state took an “intentional approach to caseload distribution,” scheduling many cases “most likely to be ineligible early in our process.” He said the department expected the initial months to have a higher closure rate because of this approach.

The letter said that while CMS recognizes the significant steps that states have taken in the unwinding process, “we urge you to take further action to reduce the number of terminations for procedural reasons as quickly as possible.”

There is an option to appeal if someone believes DPHHS made a mistake canceling their coverage. Those no longer eligible will receive a notice telling them when their coverage ends.

Redetermination packets can be accessed and completed online.

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Nicole Girten
Nicole Girten

Nicole Girten is a reporter for the Daily Montanan. She previously worked at the Great Falls Tribune as a government watchdog reporter. She holds a degree from Florida State University and a Master of Science from the Medill School of Journalism at Northwestern University.