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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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Montana

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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