Montana group launches coverage campaign after Medicaid unwinding

Late Thursday morning, representatives from Missoula community organizations packed into a conference room at Partnership Health Center to coordinate solutions to a collective problem: How to help thousands of people removed from state Medicaid programs in the last year regain health care coverage as quickly as possible.

The campaign, titled “Get Covered Again,” is spearheaded by Cover Montana, a federally supported arm of the Montana Primary Care Association that helps Montanans find and access health insurance. The group’s director, Olivia Riutta, told attendees Thursday that 1 in 10 Montanans have lost coverage since the state’s mass-eligibility review began last April, a statistic she described as a “pretty staggering coverage loss.”

“We are really interested in what we can do, across the state, to get folks covered again,” Riutta told the full room. The sooner someone can find stable coverage, she continued, the less likely they will be to have their health care interrupted or be hit with expensive medical bills. 

Over the last year, Cover Montana helped many of the more than 300,000 Montanans on Medicaid navigate the redetermination process, a multi-month whirlwind during which states began vetting eligibility for the public health program for the first time since the onset of the COVID-19 pandemic. According to the Montana Department of Public Health and Human Services’ March data update, more than 132,000 people lost coverage between April 2023 and January 2024, 64% of whom were disenrolled for procedural reasons or due to “failure to provide requested information.” Comparatively, 30% of people who lost coverage were deemed ineligible because of changes in income, household composition or other factors.

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Public health advocates, medical providers and community groups have recounted widespread anecdotes of Montanans struggling to navigate the state’s online application portal, clogged phone lines and mail notifications, or turning in their enrollment packets only to be disenrolled weeks later regardless. 

The administration of Republican Gov. Greg Gianforte, often through its appointed health department Director Charlie Brereton, has repeatedly defended the state’s federally approved redetermination plan, despite receiving federal notices in recent months about long call center wait times and high rates of childhood disenrollment. 

In response to a Democratic press event with health providers and Medicaid applicants this week, the governor’s office told KTVH News that Medicaid enrollment in Montana has returned to pre-pandemic levels and dismissed critiques it attributed to “far-left activists” who “want to overburden the system by keeping folks who are ineligible on the rolls and having Montana taxpayers foot the bill.”

“Redetermination is working as intended: people who are ineligible for Medicaid are no longer on it,” the statement said.

One by one, attendees of the Thursday meeting in Missoula shared stories about clients, patients and families who are floundering after losing Medicaid coverage for procedural reasons. 

“Sometimes they don’t realize until they’re in a crisis,” said Jill Bonny, executive director of the Poverello Center, an emergency shelter in Missoula. “They go to the Partnership [Health] Clinic that we have at the main shelter, or somewhere else, and they find out they don’t have coverage, which just adds to their crisis.”

A representative from Mountain Home Montana, a mental health center in Missoula that houses young mothers and pregnant women, said roughly half of the organization’s 70 active clients lost coverage during the unwinding period. 

“So much of the reason that our clients are still able to be covered is because they have case management and care teams that keep them enrolled when they are disenrolled,” said Development Director Kelsie Severson.

Riutta said the scale of the disenrollment calls for an all-hands-on-deck approach, in which community groups can be trained on how to help work through the state’s Medicaid application process or connect people with affordable options through the federal marketplace or their employer.

In an interview after the meeting, Riutta said Cover Montana did not invite representatives from the state health department to participate in Thursday’s discussion, emphasizing the role that front-line groups and service providers will play in re-enrollment efforts.

“I think that the lion’s share of the enrollment work that’s going to happen is really within communities,” Riutta said. “DPHHS does enrollment work all day, every day. People know to call the [Office of Public Assistance]. But I think people need to know that there are hopefully more access points to get information.”

Campaign members at the table Thursday, including Missoula Mayor Andrea Davis, swapped ideas about pop-up enrollment assistance at schools, libraries and social service organizations. Representatives of mobile crisis support teams, housing support programs and emergency shelters discussed bringing in Cover Montana to train staff on state and federal health care sign-ups and referring clients to one-on-one enrollment counseling.

“How can we all help with a guerilla marketing campaign in ways that really try to get the message out to folks where they are?” Davis said. “I’m thinking, like grocery stores, are there pop-up tables? Are there ways for community members to help volunteer in that?”

Riutta seemed enthusiastic about the brainstorming, saying the group is willing to try “anything and everything” to amplify the message about new enrollment opportunities. 

“If what we need to do is print more posters everywhere, we’ll print more posters,” she said.

Riutta said the group is trying to determine where else in the state to schedule roundtable discussions with community groups, or to deploy navigators to convene smaller groups. She estimated as many as 125,000 Montanans will need help reapplying for Medicaid or finding other insurance. 

“We want to make sure we’re having a conversation with them in the event that they do qualify, that they’re getting re-enrolled. But in the event that they don’t qualify, that they’re also getting re-enrolled in the marketplace or employer coverage,” Riutta said. “From our perspective, there’s a lot of work to be done to make sure that those 125,000 folks don’t kind of join the long-term ranks of the uninsured.”