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Federal letter expresses concerns about Montana’s Medicaid redetermination process

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Federal letter expresses concerns about Montana’s Medicaid redetermination process


HELENA — As Montana continues determining whether people can remain on the state’s Medicaid program, federal authorities have expressed some concerns about how the process has gone so far for those getting their coverage reviewed.

Last week, the Centers for Medicare and Medicaid Services sent letters to state Medicaid administrators across the country. That included a letter to the Montana Department of Public Health and Human Services, in which they cited concerns about the number of Medicaid recipients removed from the program for technical reasons, as well as the wait time to get help through a call center.

During the COVID emergency, the federal government directed that everyone on a state Medicaid program could remain enrolled without having their eligibility reconfirmed. That requirement ended on April 1, so state regulators must recheck most recipients’ eligibility annually and when they report changes like getting married or divorced or having a child.

There are a number of reasons why someone might no longer be eligible for Medicaid, but leaders say one of the most common is that their income rises out of the qualifying range.

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When the redetermination process began in Montana, about 324,000 residents were enrolled in the Medicaid and Healthy Montana Kids programs. As of July 13, data from DPHHS showed 71,930 individuals went through the process in April and May. 34,204 of them – 47.6% – didn’t have their coverage renewed. Of those, 8,433 – about a quarter – were determined to be ineligible, while the rest were removed because they failed to provide requested information, the department couldn’t reach them or for another reason.

MTN News

Overall, about 36% of all individuals whose coverage was reviewed in those two months lost coverage for what CMS described as procedural reasons. In their letter to DPHHS, CMS leaders said that high percentage “raises concerns that eligible individuals, including children, may be losing coverage.”

DPHHS leaders say they’re going to launch a public service announcement campaign in the coming weeks to highlight the importance of returning the redetermination paperwork. That campaign will run through the rest of the redetermination process – expected to last a total of ten months.

Montana is also one of 22 states that has prioritized redetermination for people who they believe are more likely to be ineligible to remain on Medicaid. Leaders say, because of that, they expect the rate of removals to go down over time.

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The CMS letter also pointed to data showing a Montanan’s average wait to connect to a call center to get help with Medicaid renewals was 42 minutes, and that an average of 40% of calls were abandoned.

CMS said the data suggested that call center issues might be “impeding equitable access to assistance and the ability for people to apply for or renew Medicaid and CHIP coverage by phone.”

DPHHS leaders told MTN the demand for the helpline has fluctuated over time, but they are evaluating staffing, scheduling and other options to address the current wait times. In addition, they said some less complex cases are being transferred to a contracted call center whose wait times are not reflected in the data from the CMS letter. They said that contracted center has average wait times of around four minutes.

“CMS sent helpful feedback to states last week,” said DPHHS communications director Jon Ebelt in a statement. “We continue to closely monitor, evaluate, and strengthen our Medicaid redetermination process with a laser focus on ensuring coverage for eligible Montanans.”

In addition, DPHHS said Montanans do not need an in-person or phone interview to apply for Medicaid or complete their redetermination packet. They encouraged them to open online accounts at apply.mt.gov.

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DPHHS says anyone who has lost Medicaid coverage can reapply at any time, and they can appeal the decision if they believe the department made an error. They are also working to connect people removed from the Medicaid program with other health insurance options, including through HealthCare.gov, the federal insurance marketplace.





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Judge strikes down Montana law defining sex as only male or female for procedural reasons – Times of India

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Judge strikes down Montana law defining sex as only male or female for procedural reasons – Times of India


MISSOULA: A judge on Tuesday struck down a Montana law that defined “sex” in state law as only male or female, finding that it was unconstitutional.
District court judge Shane Vannatta in Missoula ruled the law, passed last year, violated the state constitution because the description of the legislation did not clearly state its purpose.
Transgender, nonbinary, intersex and other plaintiffs challenged the law, similar to ones passed in Kansas and Tennessee, because they said it denies legal recognition and protections to people who are gender-nonconforming.
Vannatta did not address that argument, simply finding that the bill’s title did not explain whether the word “sex” referred to sexual intercourse or gender, and did not indicate that the words “female” and “male” would be defined in the body of the bill.
“The title does not give general notice of the character of the legislation in a way that guards against deceptive or misleading titles,” Vannatta wrote.
The bill was approved during a legislative session that also passed a ban on gender-affirming medical care for transgender minors and saw transgender lawmaker democratic rep Zooey Zephyr expelled from the house floor, following a protest against republican lawmakers who had silenced her.
The law that was struck down by Vannatta was sponsored by republican senator Carl Glimm, who said the legislation was necessary after a 2022 court ruling in which a state judge said transgender residents could change the gender markers on their birth certificates.
A spokesperson for republican governer Greg Gianforte, who signed the bill into law, did not immediately return an after-hours email seeking comment on the ruling.
The American civil liberties union of Montana praised it.
“Today’s ruling is an important vindication of the safeguards that the Montana constitution places on legislative enactments,” the group’s legal director, Alex Rate, said.





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Organizations request Montana health department investment following Medicaid redetermination • Idaho Capital Sun

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Organizations request Montana health department investment following Medicaid redetermination • Idaho Capital Sun


Thousands of Montanans lost Medicaid coverage, not because they weren’t eligible, but due to “unapproachable and unmanageable” administrative barriers at the state health department.

That’s according to a letter signed by 66 national and state organizations sent to Gov. Greg Gianforte last week asking him to include money to add additional staff to the Department of Public Health and Human Services and update outdated software, among other requests, in his budget proposal for the 2027 biennium.

The Medicaid redetermination process took place following a freeze on disenrollments during the Covid-19 pandemic, and took a total 135,000 enrollees off of Medicaid. The state’s redetermination dashboard cites the most frequent reason for disenrolling as a lack of correspondence with the department. Many former enrollees who may still be eligible now have to apply for Medicaid again for health coverage, with longer-than-usual wait times and Medicaid providers struggling to make ends meet as applications are processed.

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Health department in preliminary budget planning

The letter suggested consumer advisory groups, focus groups, surveys, and end-user testing to improve the state’s communication with clients – and said health department staffers should use plain language with clients to help reduce delays.

The state health department previously told the Daily Montanan it meets all federal standards for processing both redeterminations and new applications. Spokesperson for the department Jon Ebelt said Monday it is taking the requests in the letter under consideration in its budget planning.

“The letter makes specific budget requests, and at this time, DPHHS is in the preliminary stages of the executive budget planning process for the upcoming legislative session,” Ebelt said in a statement. “DPHHS appreciates the feedback and suggestions included in the letter and will consider them.”

The letter was addressed to Gianforte, but the Governor’s Office on Monday deferred to DPHHS in response to questions. DPHHS Director Charlie Brereton, as well as Human Services Executive Director Jessie Counts, Medicaid Chief Financial Manager Gene Hermanson and Director of Budget and Program Planning Ryan Osmundson were copied on the letter as well.

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Jackie Semmens with the Montana Budget and Policy Center, told legislators Thursday the organizations who signed onto the letter included food pantries, healthcare providers and faith organizations – places people turn to when they “can’t get the benefits they qualify for in a timely manner.”

“These organizations see people coming to food pantries when they are forced to choose between paying out of pocket for prescription or feeding their family because their Medicaid determination is delayed,” Semmens said. “These 60 plus organizations have seen firsthand how strapped the department has been during the past year, which is why they have joined together to ask the governor to improve access to public assistance.”

Organizations include the Montana Food Bank Network, the Fort Peck Tribal Health Department, Montana Head Start Association and the American Heart Association.

The letter, sent June 17, said the health department cuts made in 2017 led to 19 public assistance offices across the state to close and resulted in pressure on the staff that was left.

Medicaid unwinding exacerbated these existing issues, the letter said, and “highlighted the ways in which Montana’s safety net is outdated, inaccessible, and cumbersome for those most in need.” The organizations asked that as the governor’s administration develops its 2027 biennial budget, they invest and modernize access to Montana’s safety net services.

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Prior to each legislative session, the governor releases a budget with proposals for spending for the upcoming two fiscal years. The legislature ultimately has the power to appropriate funds, but the budget is a public statement of the investments the executive office wishes to make and approve. The legislature will meet again in January 2025.

Letter: state website is hard to navigate, more in-person assistance options needed

The organizations want to see more options for in-person assistance, which could include the reopening of rural public assistance offices. Applications completed in person are less likely to contain errors, the letter said, and would reduce procedural delays.

“In-person assistance is an essential lifeline for elderly, disabled, and rural individuals,” the organizations said.

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The state health department’s website to apply for safety net services like Medicaid or food assistance is hard to navigate, the letter said, and during the unwinding process, phone lines were jammed with people having to wait hours to speak to someone. The organizations believe the solution to the problems is better staffing at the department, although their letter did not specify how many more employees they believe are needed.

“With rural Montanans relying on these means of application, Montana should make significant investments to improve their functionality,” the letter read.

The letter said understaffing was what led to procedural delays during the Medicaid unwinding. Ebelt previously listed limited staff as one reason for Medicaid delays, along with prioritization for individuals with current inactive coverage as well as verifying previously unreported resources. He said the state meets the federal standard of paying 90 percent of “clean claims” (claims not needing additional verification) within 30 days, and 99 percent of “clean claims” in 90 days.

About 9% of cases are still pending eligibility, Counts told legislators, translating to a little under 20,000 cases.

Daily Montanan is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Daily Montanan maintains editorial independence. Contact Editor Darrell Ehrlick for questions: [email protected]. Follow Daily Montanan on Facebook and X.

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Briefs: Going to the Sun Road; Glacier Park death; Browning tax relief

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Briefs: Going to the Sun Road; Glacier Park death; Browning tax relief


GNP’s Going to the Sun Road opens for the season

Aaron Bolton | Montana Public Radio

Going to the Sun Road in Glacier National Park has fully opened for the season. Park officials opened the road Saturday.

The visitor center at Logan Pass is open, but drinking water isn’t yet available.

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The road is opening with some changes to the vehicle reservation system. A reservation is required from 6 a.m. to 3 p.m. for cars entering through West Glacier. Reservations aren’t required at the St. Mary entrance on the east side of the park.

Shuttle services along the road will begin July 1.

Woman dies after falling into St. Mary Falls in GNP

Edward O’Brien | Montana Public Radio

A Pennsylvania woman died yesterday Sunday afternoon after falling into the water in Glacier National Park.

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Park officials say the 26-year-old woman fell into the water above St. Mary Falls on the park’s east side.

According to witnesses, the woman was washed over the falls and trapped under the very cold and fast water for several minutes.

A park news release says bystanders pulled her from the water and administered CPR until emergency responders arrived.

Park rangers and an ambulance team from Babb took over CPR upon arrival.

An ALERT helicopter crew also assisted with resuscitation efforts, but the victim never regained consciousness.

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The victim’s name has not yet been released pending notification of next of kin.

The death is under investigation. It is Glacier’s first fatality of the summer season.

Browning residents to see relief after being overcharged on tax bills 

Shaylee Ragar | Montana Public Radio

State officials are working to get refunds to Browning residents who were overcharged on their property tax bills.

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Lee Montana first reported homeowners in Browning received unusually high appraisal values and property tax bills last fall — some four times the amount they paid last year.

That led the state Department of Revenue to re-evaluate the homeowners’ properties. The agency says a computing error miscalculated the values of 385 properties in town.

Bryce Kaatz with the department told lawmakers on Monday that all affected residents should receive letters with their updated appraisals this week. He said the department is working with Glacier County to issue refunds to homeowners as quickly as possible.

Kaatz says the agency is looking at safeguards to prevent the error from happening again.

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