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Medicaid unwinding deals blow to Native care in Montana

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Medicaid unwinding deals blow to Native care in Montana


Jazmin Orozco Rodriguez

(KFF) About a year into the process of redetermining Medicaid eligibility after the covid-19 public health emergency, more than 20 million people have been kicked off the joint federal-state program for low-income families.

A chorus of stories recount the ways the unwinding has upended people’s lives, but Native Americans are proving particularly vulnerable to losing coverage and face greater obstacles to reenrolling in Medicaid or finding other coverage.

“From my perspective, it did not work how it should,” said Kristin Melli, a pediatric nurse practitioner in rural Kalispell, Montana, who also provides telehealth services to tribal members on the Fort Peck Reservation.

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The redetermination process has compounded long-existing problems people on the reservation face when seeking care, she said. She saw several patients who were still eligible for benefits disenrolled. And a rise in uninsured tribal members undercuts their health systems, threatening the already tenuous access to care in Native communities.

One teenager, Melli recalled, lost coverage while seeking lifesaving care. Routine lab work raised flags, and in follow-ups Melli discovered the girl had a condition that could have killed her if untreated. Melli did not disclose details, to protect the patient’s privacy.

Melli said she spent weeks working with tribal nurses to coordinate lab monitoring and consultations with specialists for her patient. It wasn’t until the teen went to a specialist that Melli received a call saying she had been dropped from Medicaid coverage.

The girl’s parents told Melli they had reapplied to Medicaid a month earlier but hadn’t heard back. Melli’s patient eventually got the medication she needed with help from a pharmacist. The unwinding presented an unnecessary and burdensome obstacle to care.

Pat Flowers, Montana Democratic Senate minority leader, said during a political event in early April that 13,000 tribal members had been disenrolled in the state.

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Native American and Alaska Native adults are enrolled in Medicaid at higher rates than their white counterparts, yet some tribal leaders still didn’t know exactly how many of their members had been disenrolled as of a survey conducted in February and March. The Tribal Self-Governance Advisory Committee of the Indian Health Service conducted and published the survey. Respondents included tribal leaders from Alaska, Arizona, Idaho, Montana, and New Mexico, among other states.

Tribal leaders reported many challenges related to the redetermination, including a lack of timely information provided to tribal members, patients unaware of the process or their disenrollment, long processing times, lack of staffing at the tribal level, lack of communication from their states, concerns with obtaining accurate tribal data, and in cases in which states have shared data, difficulties interpreting it.

Research and policy experts initially feared that vulnerable populations, including rural Indigenous communities and families of color, would experience greater and unique obstacles to renewing their health coverage and would be disproportionately harmed.

“They have a lot at stake and a lot to lose in this process,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and a research professor at the McCourt School of Public Policy. “I fear that that prediction is coming true.”

Cammie DuPuis-Pablo, tribal health communications director for the Confederated Salish and Kootenai Tribes in Montana, said the tribes don’t have an exact number of their members disenrolled since the redetermination began, but know some who lost coverage as far back as July still haven’t been reenrolled.

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The tribes hosted their first outreach event in late April as part of their effort to help members through the process. The health care resource division is meeting people at home, making calls, and planning more events.

The tribes receive a list of members’ Medicaid status each month, DuPuis-Pablo said, but a list of those no longer insured by Medicaid would be more helpful.

Because of those data deficits, it’s unclear how many tribal members have been disenrolled.

“We are at the mercy of state Medicaid agencies on what they’re willing to share,” said Yvonne Myers, consultant on the Affordable Care Act and Medicaid for Citizen Potawatomi Nation Health Services in Oklahoma.

In Alaska, tribal health leaders struck a data-sharing agreement with the state in July but didn’t begin receiving information about their members’ coverage for about a month — at which point more than 9,500 Alaskans had already been disenrolled for procedural reasons.

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“We already lost those people,” said Gennifer Moreau-Johnson, senior policy adviser in the Department of Intergovernmental Affairs at the Alaska Native Tribal Health Consortium, a nonprofit organization. “That’s a real impact.”

Because federal regulations don’t require states to track or report race and ethnicity data for people they disenroll, fewer than 10 states collect such information. While the data from these states does not show a higher rate of loss of coverage by race, a KFF report states that the data is limited and that a more accurate picture would require more demographic reporting from more states.

Tribal health leaders are concerned that a high number of disenrollments among their members is financially undercutting their health systems and ability to provide care.

“Just because they’ve fallen off Medicaid doesn’t mean we stop serving them,” said Jim Roberts, senior executive liaison in the Department of Intergovernmental Affairs of the Alaska Native Tribal Health Consortium. “It means we’re more reliant on other sources of funding to provide that care that are already underresourced.”

Three in 10 Native American and Alaska Native people younger than 65 rely on Medicaid, compared with 15% of their white counterparts. The Indian Health Service is responsible for providing care to approximately 2.6 million of the 9.7 million Native Americans and Alaska Natives in the U.S., but services vary across regions, clinics, and health centers. The agency itself has been chronically underfunded and unable to meet the needs of the population. For fiscal year 2024, Congress approved $6.96 billion for IHS, far less than the $51.4 billion tribal leaders called for.

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Because of that historical deficit, tribal health systems lean on Medicaid reimbursement and other third-party payers, like Medicare, the Department of Veterans Affairs, and private insurance, to help fill the gap. Medicaid accounted for two-thirds of third-party IHS revenues as of 2021.

Some tribal health systems receive more federal funding through Medicaid than from IHS, Roberts said.

Tribal health leaders fear diminishing Medicaid dollars will exacerbate the long-standing health disparities — such as lower life expectancy, higher rates of chronic disease, and inferior access to care — that plague Native Americans.

The unwinding has become “all-consuming,” said Monique Martin, vice president of intergovernmental affairs for the Alaska Native Tribal Health Consortium.

“The state’s really having that focus be right into the minutiae of administrative tasks, like: How do we send text messages to 7,000 people?” Martin said. “We would much rather be talking about: How do we address social determinants of health?”

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Melli said she has stopped hearing of tribal members on the Fort Peck Reservation losing their Medicaid coverage, but she wonders if that means disenrolled people didn’t seek help.

“Those are the ones that we really worry about,” she said, “all of these silent cases. … We only know about the ones we actually see.”





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Broadband access is expanding in Montana, but rural areas still lag behind

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Broadband access is expanding in Montana, but rural areas still lag behind


In the southeastern Montana town of Belfry, 65-year-old resident Mary Boyer reflects on her relationship with technology.

“I’m a green-ledger girl,” Boyer said. “I can handwrite. I don’t like calculators. I never owned a television, I have a crank Victrola for music.”

Boyer’s home is about an hour south of Billings. The Beartooth and Pryor Mountains flank Belfry, as the Clarks Fork of the Yellowstone River meanders through it.

Belfry, MT is flanked by the Beartooth and Pryor Mountains. This terrain is challenging and expensive when it comes to installing fiber optic cable, which in some parts of the state can cost up to $300,000 to reach one home or business, according to ConnectMT Director Misty Ann Giles.

She said technology has always been slow to come to their town.

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“We had a heck of a time getting songs – because we have to do it over the internet – for the karaoke machine,” she said. “And all of a sudden halfway through a song there’s no words or there’s no karaoke whatsoever.”

Boyer knows connectivity goes beyond a karaoke machine.

Before this year, she said their internet service couldn’t meet the community’s needs. Her neighbors rely on it for telehealth appointments, education and commerce.

“I think it’s all about the community and keeping them in touch with the outside world,” she said.

Montana ranks among the lowest in the country when it comes to internet access. And rural places disproportionately lack access to high speed connectivity compared to urban.

Montana ranks among the lowest in the country when it comes to internet access. Broadband Now, an independent research organization, ranked Montana second to last in the nation for internet speeds and affordability. And rural places disproportionately lack access to high speed connectivity compared to urban; this is known as the digital divide.

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State officials and telecommunications companies have been trying to change that. Over the last few years, just shy of a billion dollars in federal funding aimed at tackling this issue came into the state. The goal is to use it to close the digital divide for good.

In the southern end of Belfry, Jay Velez stands in front of his restaurant, the Silvertip, admiring the scenery.

“What a view, man!” he said, looking toward the Beartooth Mountains. “It doesn’t suck here.”

His restaurant serves as a local watering hole. It offers the karaoke night coveted by Boyer. And this summer, the Silvertip’s internet got better.

The Silvertip Restaurant in Belfry, MT. The restaurant’s internet speeds got an upgrade after Nemont Communications finished building fiber optic lines to the town. That work was funded through a federal program aimed at closing the digital divide.
The Silvertip Restaurant in Belfry, MT. The restaurant’s internet speeds got an upgrade after Nemont Communications finished building fiber optic lines to the town. That work was funded through a federal program aimed at closing the digital divide.

“We just rely on it for our point of sale systems, and so far, it’s been working great,” he said.

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His improved internet is due to newly installed fixed fiber optic lines. These are thick cables laid in the ground. They’re considered the “gold standard” for broadband connectivity.

But this technology is expensive to install, and it’s been slow to reach towns like Belfry.

“We’re way behind, in looking at the grander sphere of the problem,” said Misty Ann Giles, the head of the state’s broadband office ConnectMT. “We are farther behind our sister states. Montana does have a lot of challenges when it comes to thinking about internet access.”

Government-led efforts to close the digital divide have been underway for decades. The federal government established the Universal Service Fund in 1996, prescribing that “all Americans” should have access to basic connectivity. The fund subsidizes fiber installation and maintenance in remote areas.

But it wasn’t enough. So, another project emerged in 2018. The U.S. Department of Agriculture’s ReConnect program offers federal funds and loans to expand internet access.

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Giles helped stand-up the program as former Chief of Staff at the agency’s Rural Development office.

“A lot of the work we did when we were at USDA when we first came into office was trying to look at the bigger Rubik’s Cube of, why are rural communities lacking some core services when it comes to education, telehealth, things like that in their communities,” Giles said. “And what it all came down to was connectivity.”

This connectivity became even more imperative during the pandemic. Business, community, health care and education all required a stable internet.

Belfry is flanked by the Beartooth and Pryor Mountains. This terrain is challenging and expensive when it comes to installing fiber optic cable, which in some parts of the state can cost up to $300,000 to reach one home or business, according to ConnectMT Director Misty Ann Giles.
Belfry is flanked by the Beartooth and Pryor Mountains. This terrain is challenging and expensive when it comes to installing fiber optic cable, which in some parts of the state can cost up to $300,000 to reach one home or business, according to ConnectMT Director Misty Ann Giles.

According to the Federal Communications Commission, broadband expansion timelines considered reasonable pre-COVID-19 became “unworkable,” and the Commission pushed to get rural communities connected faster. So the federal government launched several new programs.

Since 2019, around $900 million from four federal programs for rural broadband expansion has flowed into the state.

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Since 2019, around $900 million from four federal programs for rural broadband expansion has flowed into the state.

The main sources include funds from the ReConnect Program, which go to telecom companies through grants and loans. Those total around $144 million for Montana-focused projects. Then there’s the American Rescue Plan Act, which provided $310 million; The Broadband Equity Access and Development program, which allotted around $308 million; Lastly, there’s the FCC’s Rural Digital Opportunity Fund, which provided Montana $126 million for a 10-year period during its Phase I auction.

And it’s through these programs that Belfry’s internet just got a little better.

Back in southeastern Montana, Nemont Communications Chief Operating Officer Scott Paul drives through the 250-resident town on a sunny October afternoon.

“You probably didn’t see it, but look for an orange capped plastic pole,” he said, pointing out markers of their recent efforts. “Beneath that orange-capped plastic pole, there is gonna be a handhole. And then between those plastic poles, there’s fiber that’s buried underground.”

White poles with orange caps mark places Nemont Communications recently installed fiber optic to bring better internet speeds to Belfry, MT. The work was funded in part by the USDA’s ReConnect program, which funds broadband buildout in rural areas.
White poles with orange caps mark places Nemont Communications recently installed fiber optic to bring better internet speeds to Belfry, MT. The work was funded in part by the USDA’s ReConnect program, which funds broadband buildout in rural areas.

Nemont just replaced Belfry’s copper wire laid around the 1970s. Paul said copper was great for dial-up internet, but fails at providing the internet speeds we expect today. But installing fiber in Montana is expensive. It can cost up to $300,000 to reach a single home or business, according to Giles.

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“If you’re trying to put all of this fiber into an area that’s all rock, then it becomes a lot more expensive because rock’s a lot harder to get through than the dirt,” he said.

For Belfry’s project, Nemont received $10 million ReConnect dollars to build fiber for around 1,000 households in 500 square miles. That’s an area the size of Los Angeles. Paul said they installed 80 miles of fiber just to reach Belfry.

Most companies rely on their customer base to cover the costs of installing internet infrastructure. But in low population states like Montana, that model does not always work. Paul said that’s why these funds are so important.

“It’s allowing us to escalate the speed of doing that,” he said. “We’re doing a little bit more now than we have done in the past, for that reason.”

Dozens of companies like Nemont have leveraged these federal programs to try and reach more residents. Sometimes the costs still exceed what they can afford, and they default.

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According to the FCC, Montana’s broadband coverage increased 10 percent between 2023 and 2024. But there’s more work to be done. 70,000 homes and businesses across Montana still need better internet.

Some progress has been made. According to the FCC, Montana’s broadband coverage increased 10 percent between 2023 and 2024. But there’s more work to be done. 70,000 homes and businesses across Montana still need better internet.

And rural residents like Mary Boyer know how necessary it is to be connected.

“If we didn’t have the access to the good communications, we could be in a world of horse pucky,” she said.

State officials hope to bridge the digital divide by the end of the decade.

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Humane Society of Western Montana has many pets for adoption

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Humane Society of Western Montana has many pets for adoption


Humane Society of Western Montana’s Director of Marketing Katie Hofschield dropped by NBC Montana Today with special guest Lady Bird.

Lady Bird is a 9-year-old mixed breed who is available for adoption. Lady Bird is house and crate trained and in general is a very laid back dog who loves cheese.

The Humane Society of Western Montana currently has many animals looking for homes, including several older pets, cats, plus two guinea pigs and a rabbit.

The Humane Society of Western Montana runs an annual pet food pantry, but this year they’re expanding into a larger-scale pet food relief project due to holiday and financial pressures on families.

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Through a partnership with Greater Good Charities and the Montana Food Bank Network, they received 25 pallets (almost 20,000 pounds) of pet food, which will be stored in a former food bank facility and distributed across the state, including to tribal partners.

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Former Montana Heritage Commission director sentenced in embezzlement scheme

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Former Montana Heritage Commission director sentenced in embezzlement scheme


Former Montana Heritage Commission Executive Director Michael Elijah Allen was sentenced Thursday to 10-years in the Montana State Prison with seven years suspended for stealing public funds from the state agency charged with preserving some of Montana’s most significant historic sites.

Lewis and Clark County District Court Judge Kathy Seeley said she took no pleasure in imposing the sentence but told Allen he was the brains behind this operation of years of theft and fraud. On a count of theft by embezzlement as part of a common scheme, Seeley sentenced Allen to 10 years at the Montana State Prison with seven years suspended, and imposed a concurrent, fully suspended 14-year term on a felony money laundering count.

“You have destroyed yourself,” Seeley said. “You understand that. I hope you do. This is not anybody but you that did this.”

Allen was ordered to pay $280,000 in restitution to the Montana Heritage Commission, plus a 10% administrative fee, and a series of standard court costs and fees, including a presentence investigation fee and victim-witness surcharge. He received credit for eight days previously served in custody, from Dec. 27, 2024, through Jan. 3, 2025, and was barred from having contact with the Department of Commerce or related entities as he serves his sentence under conditions laid out in a plea agreement.

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Prosecutors urged a stiffer punishment, asking the court to impose a 20-year prison sentence with 10 years suspended, arguing that Allen’s years-long scheme was a serious breach of public trust that demanded a lengthy custodial term. Deputy County Attorney Kevin Downs told the court that every defendant in similar embezzlement and financial-crimes cases submitted for comparison had received multi-year prison time and said a 10-year effective prison term was warranted to deter others from stealing public funds.

“He was the one that made this happen. He greased the wheels to steal from people,” Downs said. “This sentence sends a message to people. The people that work in any state agency, god forbid, that if you steal there will be significant consequence.”

Allen’s attorney asked Seeley for a lengthy but largely suspended sentence, arguing that a shorter period of incarceration — about two years, roughly double that imposed on co-defendant Casey Jack Steinke — would still hold Allen accountable while allowing him to work and pay restitution more quickly. The defense said Allen has suffered enough with the public humiliation and collateral consequences, including the loss of his career, voting rights and ability to serve on a jury or possess firearms.

Brenda Elias, chief legal counsel for the Montana Department of Commerce, told the court Allen had been a long-time state employee with significant autonomy as the Heritage Commission’s director and had been compensated for his work. She said Allen abused trust, manipulating people and resources.

“Hundreds of thousands of dollars that should have gone to preserve Montana’s heritage were diverted to Mr. Allen’s personal use,” Elias said.

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Elias said Allen served as executive director from 2012 to 2024 and said the Heritage Commission has never been financially self-sufficient, relying heavily on bed tax revenue and other support from the Department of Commerce.

“The Heritage Commission continues to realize the impact of these crimes to this day, and it will take many years for the Commission to recover,” Elias said.

Detective Nathan Casey of the Helena Police Department, a veteran investigator in financial crimes, testified that he was contacted by Commerce employees in mid-2024 after they uncovered significant irregularities, prompting a wide-ranging probe. Casey said investigators ultimately reviewed roughly 744 pages of documents which included invoices, contracts and procurement justifications tied to a state-issued purchasing card controlled by Allen.

According to earlier court records, Allen used his position as head of the Heritage Commission to channel roughly $350,000 in commission funds to Steinke between 2020 and 2024, often through invoices for work that was not legitimately performed. In addition to those payments, investigators found evidence that Allen used public money to cover rent, educational expenses and other personal costs, and that Steinke lived rent-free in Reeder’s Alley, one of the commission’s historic properties, during the scheme.

Steinke, who was charged with accountability for theft by embezzlement and felony money laundering, previously pleaded guilty to one embezzlement-related charge and the money laundering count under a plea deal that called for prosecutors to recommend a 20-year prison sentence with 15 years suspended. As part of that agreement, Steinke agreed to pay $100,000 in restitution, including a $20,000 upfront payment at sentencing.

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The embezzlement case comes as the Heritage Commission, which manages historic properties, is facing financial pressure. According to reporting from the Daily Montanan, the Commission is obligated to provide $1.1 million annually to the state but has only generated an average of about $750,000 in recent years, leaving less available for capital improvements than needed to maintain historic buildings.

Allen, 49, told the court he accepted full responsibility for his actions, saying he was ashamed and that the crimes were an aberration from how he had otherwise lived his life. He described the embarrassment his children have faced as his case played out publicly, and said he hopes to work and resume making restitution payments.

“I apologize to my friends and to my community,” Allen said. “I’m incredibly ashamed of the actions.”



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