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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

Montana Supreme Court upholds landmark youth climate ruling

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Montana Supreme Court upholds landmark youth climate ruling


Montana’s Supreme Court has upheld a lower court’s decision that had sided with 16 young activists who argued that the state violated their right to a clean environment.

The lawsuit was brought by students arguing that a state law banning the consideration of climate when choosing energy policy was unconstitutional.

In a 6-to-1 ruling, the top court found that the plaintiffs, between ages five and 22, had a “fundamental constitutional right to a clean and healthful environment”.

Wednesday’s ruling came after a district court’s decision last year was appealed by the state. Similar climate lawsuits are ongoing across the US but this is first of its kind a from a state supreme court.

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The lawsuit targeted a 2011 state law that made it illegal for environmental reviews to consider climate impacts when deciding on new projects, like building new power plants.

It cited a 50-year-old constitutional clause that guaranteed the “state and each person shall maintain and improve a clean and healthful environment in Montana for present and future generations”.

The ruling on Wednesday stated that the “plaintiffs showed at trial – without dispute – that climate change is harming Montana’s environmental life support system now and with increasing severity for the foreseeable future” .

Rikki Held, the lead plaintiff in the lawsuit, said in a statement that “this ruling is a victory not just for us, but for every young person whose future is threatened by climate change”.

Montana state officials expressed disappointment with the court’s decision.

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Governor Greg Gianforte said his office was still assessing the ruling, but predicted the impact would be “perpetual lawsuits that will waste taxpayer dollars and drive up energy bills for hardworking Montanans”.

Western Environmental Law Center, which represented the young plaintiffs, said in a statement that the decision marks “a turning point in Montana’s energy policy”.

It said plaintiffs and their legal team “are committed to ensuring the full implementation of the ruling”.

Similar cases are scheduled to be heard in several other states, including Hawaii, Utah and Alaska, as well as in countries like Australia, New Zealand, Pakistan, Colombia and Uganda.



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Montana Supreme Court affirms decision in landmark youth climate case

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Montana Supreme Court affirms decision in landmark youth climate case


What’s New

The Montana Supreme Court on Wednesday affirmed a landmark climate decision that declared the state was violating residents’ constitutional right to a clean environment by allowing oil, gas and coal projects without regard for global warming.

Why It Matters

The decision reinforces an August 2023 ruling by District Court Judge Kathy Seeley, who found that Montana’s practices violated its residents’ constitutional right to a “clean and healthful environment.”

This pivotal case, spearheaded by a group of young plaintiffs aged 6 to 23, represented a milestone for climate advocates seeking judicial intervention to compel governmental action on climate change.

What To Know

On Wednesday in a 6-1 ruling, the Montana Supreme Court upheld the August 2023 decision.

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The court’s decision strikes down a state policy that prohibited the consideration of greenhouse gas emissions in granting permits for fossil fuel development.

The state had previously appealed the ruling by Seeley, and arguments were heard in July, in which the state argued that greenhouse gases released from Montana fossil fuel projects are minuscule on a global scale and reducing them would have no effect on climate change.

Dale Schowengerdt, representing Montana Governor Greg Gianforte and state environmental agencies, argues before the Montana Supreme Court on July 10, 2024, in Helena, Montana, in the youth climate lawsuit Held v. Montana. The Montana Supreme…


Thom Bridge/Independent Record/ AP

Chief Justice Mike McGrath dismissed the state’s argument that Montana’s emissions are insignificant on a global scale, likening the defense to an “everyone else is doing it” excuse.

McGrath wrote, “The right to a clean and healthful environment is meaningless if the State abdicates its responsibility to protect it.”

What Are People Saying

Melissa Hornbein, an attorney with the Western Environmental Law Center and attorney for the plaintiffs said, “With the ruling now in place, the Montana Supreme Court’s decision compels the state to carefully assess the greenhouse gas emissions and climate impacts of all future fossil fuel permits.”

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Chief Justice Mike McGrath wrote for the majority: “Plaintiffs may enforce their constitutional right to a clean and healthful environment against the State, which owes them that affirmative duty, without requiring everyone else to stop jumping off bridges or adding fuel to the fire. Otherwise the right to a clean and healthful environment is meaningless.”

Republican Governor Greg Gianforte said in a statement that the state was still reviewing the decision, but said it will lead to “perpetual lawsuits that will waste taxpayer dollars and drive up energy bills for hardworking Montanans.

Pushback From State Leadership

The ruling has sparked a backlash from Gianforte, who criticized the court for what he described as judicial overreach. He warned the decision could invite an onslaught of lawsuits, increase energy costs for Montanans and hinder the state’s “all-of-the-above” energy strategy.

“This Court continues to step outside of its lane to tread on the right of the Legislature, the elected representatives of the people, to make policy,” he said in a statement. “This decision does nothing more than declare open season on Montana’s all-of-the-above approach to energy, which is key to providing affordable and reliable energy to homes, schools, and businesses across our state.”

Gianforte also convened energy stakeholders earlier this week to discuss boosting production to meet rising demand, emphasizing the need for “unleashing American energy” to maintain grid stability.

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The Plaintiffs’ Perspective

For the 16 young plaintiffs, the court’s decision validates their personal struggles with the tangible effects of climate change. In a Wednesday statement, lead plaintiff Rikki Held called the ruling “a victory not just for us, but for every young person whose future is threatened by climate change.”

During the trial, the plaintiffs described how worsening wildfires, droughts and diminishing snowpack have disrupted their lives, polluted the air and depleted vital natural resources. They argued that the state’s failure to address these challenges imperils their future and violates their constitutional rights.

What Happens Next

The ruling has positioned Montana as a flashpoint in the national debate over climate accountability, potentially inspiring similar legal challenges across the United States.

This article includes reporting from The Associated Press.

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Pregnant woman claims Montana Highway Patrol wrongfully arrested her for DUI

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Pregnant woman claims Montana Highway Patrol wrongfully arrested her for DUI


BOZEMAN — A pregnant woman from Sheridan is claiming she was wrongfully arrested by the Montana Highway Patrol (MHP) for allegedly driving under the influence during a traffic stop near Bozeman.

“I was just pretty shocked. And I constantly told him I’m pregnant, and I haven’t drunk in probably eight months,” says Alyssa Johnson.

Alyssa is a photographer from Sheridan who, at 22 weeks pregnant, was pulled over by an MHP trooper on Dec. 1, 2024 for an alleged traffic violation.

“I have a stutter, and he thought I was slurring so he pretty much said can you step out of the car. Made me do all these kinds of tests,” says Alyssa.

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Alyssa explains that she has severe dyslexia, which makes understanding directions, and completing any sort of test, difficult.

“I mean, Alyssa, when she was in school, she used to have extra time to take an exam and she’d have questions read to her,” explains Alyssa’s husband, Tim Johnson.

Alyssa says in addition to her mental handicap, she was in a state of panic during the traffic stop—affecting her ability to give a proper breathalyzer result.

“They were saying that since I couldn’t breathe through the breathalyzer and the testing wasn’t doing good, they arrested me and pretty much took me to the hospital for more blood work,” she says.

A written statement by her therapist confirms Alyssa’s dyslexia diagnosis.

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And after the incident, the couple got a third-party blood test—because the one conducted by law enforcement could take up to eight weeks to return.

The blood test, provided by the Johnsons, shows negative for any type of drug.

Alyssa says, “I take a prenatal, an aspirin for my blood pressure, and stuff for my heartburn, like Tums. Just like simple stuff.”

Tim explains that in addition to expecting their second child, they’re currently building a home—making the cost of bail and towing a hard hit on finances.

He says, “We have a budget to stick to and the budget doesn’t include any unexpected costs like this.”

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Tim says this is an opportunity for police to receive better training on mental impairments and hopes that charges will be dropped from Alyssa’s record.

“And I understand they have to do their job too. I mean, support police. But this wasn’t right to do,” she says.

The couple says they have filed a formal complaint with MHP.

I reached out to MHP for comment but did not receive a response regarding the incident. We will update this story if we hear back.





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