Feds signal alarm over Montana’s drop in childhood Medicaid coverage

This story is excerpted from the MT Lowdown, a weekly newsletter digest containing original reporting and analysis published every Friday.

The federal government’s top health official said this week that he is “deeply alarmed” by a recent drop in the number of Montana children who are covered by Medicaid. The Biden administration urged the state health department to do more to ensure that eligible youth keep their health insurance as it conducts its first review of Medicaid rolls since states were prohibited from removing participants during the COVID-19 pandemic.

In a letter dated Dec. 18, U.S. Department of Health and Human Services Secretary Xavier Becerra told Gov. Greg Gianforte that Montana was among nine states with the highest rates of childhood Medicaid disenrollment between March and September, the first several months of the nationwide redetermination process. Montana’s youth caseload shrunk by 18% during that time period, Becerra wrote, a reduction of 24,175 children.

“Because all children deserve to have access to comprehensive health coverage, I urge you to ensure that no child in your state who still meets eligibility criteria for Medicaid or [Children’s Health Insurance Program] loses their health coverage due to ‘red tape’ or other avoidable reasons,” Becerra wrote, adding that his department “stands ready” to help Montana achieve that goal.

Most of the 112,453 Montanans who have lost Medicaid coverage since April, nearly 64%, have been removed from the program for not providing the state health department with requested paperwork, according to the agency’s public-facing dashboard. Just over 30% have been removed because the department made an evidence-based ruling that they were no longer eligible for coverage, either because of a change in income, household composition or other factors.

The state’s online display does not include data for specific age groups, racial groups, counties or types of Medicaid beneficiaries. In a Thursday email exchange, a spokesperson for the health department declined to say how many children have lost coverage and been subsequently re-enrolled since April, directing MTFP to file a public records request for the figures not included in its monthly updates.

In order to minimize the number of eligible children culled from the program over paperwork problems, Becerra suggested Montana create a 12-month timeline for reviewing minors’ eligibility, which would keep children covered for longer while the state tries to track down information. The secretary also suggested “targeted, on-the-ground outreach efforts” to reach unresponsive families through schools and community groups and using existing information from federal food and cash assistance programs to determine eligibility.

The state health department said Thursday that it is already using data from those programs and enacting other strategies allowed by the federal oversight agency. But Montana’s Department of Public Health and Human Services Director Charlie Brereton has resisted various calls to slow down the review process so participants have more time to respond to the state’s inquiries. 

“I will not be pausing the process. I’m not adding more months to the process,” Brereton told lawmakers on an interim budget committee a few days before Becerra’s letter was sent. “We’re sticking to our 10-month plan.”

The agency estimates that eligibility reviews have begun for roughly 90% of enrollees as of mid-December and says its last batch will be initiated in January. By the springtime, the department will likely have a better understanding of how many people — including Montana’s youngest residents — have ended up losing or keeping coverage.