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Montana lawmakers hear conflicting arguments on renewing expanded Medicaid program • Daily Montanan

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Montana lawmakers hear conflicting arguments on renewing expanded Medicaid program • Daily Montanan


Lawmakers on the health and human services budget committee on Wednesday heard opposing presentations about Medicaid expansion in Montana and its purported benefits and drawbacks as the legislature sets up what will likely be one of its biggest decisions next year – whether it should continue the expanded Medicaid program or let it expire next June.

Under Medicaid expansion, which was created under the Affordable Care Act, able-bodied adults earning up to 138% of the Federal Poverty Level – around $20,782 annually this year for a single person – can get health insurance coverage paid for primarily by the federal government, but partially the state. As of June in Montana, there were around 81,000 people covered under expanded Medicaid out of a total of 228,000 covered by the overall program. Medicaid covers about one-fifth of Montana’s population.

That’s down from a peak of around 302,000 Montanans who were covered in June last year as the state started its unwinding process to boot people off the program who had automatically been re-enrolled during the COVID-19 federal emergency but were no longer eligible after the emergency ended.

Montana first expanded Medicaid here in 2015 and renewed the expansion in 2019. But the expanded portion of the program will expire in June if lawmakers choose not to renew it again during the 2025 legislative session that starts in January and will run for as long as 90 days.

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Only 10 states have not expanded Medicaid coverage in the decade they have had the option.

The topic of expansion is sure to bring dozens of lobbyists, health care workers and officials, and people covered by expanded Medicaid to the Capitol to offer their viewpoints on what is currently a $2.4 billion program in Montana overall, with about $100 million annually initially coming out of the state’s General Fund for the expanded coverage. Nearly 80% of the Montana Medicaid budget is paid for with federal funds, and states receive a 90% match for funds for the expanded population.

Medicaid enrollment in 2022 as a percentage of each Montana county’s population. (Source: Montana Healthcare Foundation)

Wednesday’s presentations offered starkly different viewpoints on the expanded portion. The first came from the data and analytics director of the Foundation for Government Accountability, a right-leaning think tank whose goals include stopping Medicaid expansion, and from the president of Paragon Health Institute, who was a special assistant for economic policy to former President Donald Trump.

The second came from two officials with policy firm Manatt Health, who outlined for lawmakers a report it compiled for the Montana Healthcare Foundation, a private foundation that works on health policy, that showed the benefits of Medicaid expansion in Montana for the past nine years.

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Presenters say Medicaid keeping people from working, costing hospitals

The presentations from the former group by Hayden Dublois, the data and analytics director for the Foundation for Government Accountability, and Brian Blase, the president of Paragon, focused primarily on their contention that Medicaid expansion has ballooned the coverage pool beyond what was initially expected, benefited the health care industry over patients, put resources toward able-bodied adults instead of children and people with disabilities, and allowed people who are covered not to work.

Dublois said a public records request he submitted to the Montana Department of Public Health and Human Services for information on how many Medicaid recipients in Montana were working between 2019 and 2022. He claimed the data he received showed 54% of recipients in 2019 showed no earned income and that the number had jumped to 72% in 2022. The Manatt presentation would later on claim 66% of recipients were working and another 11% in school.

A slide from the Paragon presentation alleging expansion populations are costing more than forecast. (Source: Paragon Health Institute)
A slide from the Paragon presentation alleging expansion populations are costing more than forecast. (Source: Paragon Health Institute)

He said Montana’s slight dip from 23rd healthiest state in the nation in 2015 to 24th healthiest, according to United Health Foundation data, meant that claims that Medicaid helped bolster public health were not true.

And he lamented that Montana hospital profits had decreased after Medicaid expansion due in part to reimbursement rates under expansion and to costs rising during a six-year period despite the state and federal government spending double what it had originally planned to for expansion because more people were eligible than expected.

“Montana’s relative ranking in health outcomes has dropped and the preponderance of the research has shown that in rural areas in particular, outcomes are either nonexistent in terms of improvement or actually result in worsened outcomes than was expected,” Dublois said. “Hospitals are still under financial strain because cost increases outweighed the revenue gains post-expansion. Spending is up and enrollment is up.”

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Blase gave a similar presentation, lamenting what he said was an overly costly expansion program that cost other Medicaid recipients quality care and saying there was “no health benefit” associated with Medicaid expansion. He, like Dublois, suggested that the expansion population would be better off getting private insurance or insurance from the ACA marketplace.

“If Montana were to not have Medicaid expansion, the people above 100% of the poverty line, they would move to the exchanges; they would qualify for a very large premium tax credit,” he said. “…So you would have a loss in Medicaid but you would have a significant increase in both private coverage as well as in employer coverage because some of those individuals who are on Medicaid would otherwise be on an employer plan.”

In response to a question from Sen. Carl Glimm, R-Kila, about what population he estimated would fall into that category, Hayden said while he hadn’t looked deeply at data, he believed roughly 20,000 to 30,000 might be eligible for what he called “enhanced private exchange coverage.”

Other group says expanded Medicaid benefitting Montana

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The presentation from Manatt Health senior managing director Patti Boozang and senior adviser Zoe Barnard essentially took the opposite stance and highlighted what the two said were vast benefits to Medicaid expansion in Montana and other states during the past decade.

A slide from the Manatt Health presentation showing Medicaid costs and the share paid by each entity. (Source: Manatt Health/Montana Healthcare Foundation)
A slide from the Manatt Health presentation showing Medicaid costs and the share paid by each entity. (Source: Manatt Health/Montana Healthcare Foundation)

“We’ve had expansion in place for quite a long time now, and there has been a lot of research, a lot of academic studies looking at the impact of Medicaid expansion on coverage, on access, on outcomes,” Boozang told the committee. “And I think the punchline here is that the overwhelming evidence is what Medicaid expansion has had positive effects on all of those measures of success or what we care about in our healthcare system and in our coverage programs.”

She pointed out that spending per Medicaid enrollee in all expansion states is higher for all Medicaid-eligible groups than in non-expansion states, that states have increasingly expanded Medicaid during the past seven years, including seven states by ballot initiative, and that most studies show expansion has positive overall effects for providers, users and states while lowering uncompensated care costs for hospitals.

Barnard told the budget committee that the expanded Medicaid program in Montana has reduced the uninsured rate by 30%, from 16.4% in 2015 to 11.4% in 2022, by filling the gap for people who would not typically qualify for Medicaid or employer-sponsored insurance.

Rep. Mary Caferro, D-Helena, noted that someone working on Montana’s minimum wage would make around $1,000 more annually than the 138% of the Federal Poverty Level and would not qualify even under expansion.

“I know you didn’t ask that, but I thought it might be useful,” she told the committee chair.

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Barnard said Medicaid costs in 2023 were $2.4 billion, of which about 79% was funded by the federal government, 13% by the state General Fund, and 8% by special revenue funds. She said Medicaid expansion costs about $100 million a year, but about 25% is paid by hospitals.

But the state has since 2015 spent an average of 13% of the General Fund on Medicaid each year, Barnard said, meaning overall spending has only fluctuated by about $40,000 between 2015 and 2022.

She said expansion has reduced the cost of uncompensated care for Montana hospitals by about $150 million during the course of seven years. And she said Medicaid expansion has increased access to preventative care and behavioral health services.

Discussing the work requirement portion that has been part of the Medicaid expansion discussion in Montana for years, including a Senate bill that was shot down during the 2023 session, Barnard said a University of Montana economist’s analysis showed Medicaid did not decrease the labor force participation and that around 80% of adults receiving Medicaid are working or in school.

U.S. Bureau of Labor and Statistics data show Montana’s labor force participation rate was about 63.5% in 2015 and is currently around 62.9%. A poll released in early May found nearly three-in-four Montanans supported keeping expanded Medicaid.

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“Montanans need to understand that expansion is not a government program keeping people form working,” Barnard said.



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Montana cowboys help build trauma ranch for Israeli soldiers

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Montana cowboys help build trauma ranch for Israeli soldiers


The hills of the northern Judean Desert will soon turn yellow and dry. For now, they are covered in green bloom, dotted with bursts of purple and yellow wildflowers, butterflies hovering above them. From a hilltop in the Binyamin region, where Ruthy and Haim Mann run their therapeutic horse ranch, the view opens wide: the Moab Mountains to the east, the Binyamin hills to the north, Wadi Qelt plunging dramatically toward the Jordan Valley and the northern Dead Sea. At moments, when the haze lifts, Herod’s winter palace can be seen in the distance on the other side of the wadi.

Biblical history feels at home here. Philistines and Crusaders, Babylonians and Hasmoneans, Assyrians, Byzantines and Seleucids all passed through. Joshua, Saul and Jonathan fought nearby. David hid in these hills. On one of the mountains opposite us, the Good Samaritan once passed, refusing to ignore a wounded man lying by the roadside and bandaging his injuries.

The desert has seen much. But a band of real-life cowboys from Montana, pointed boots, wide-brimmed hats and oversized belt buckles, is new even for this landscape. But a band of cowboys who wear Tzitzit (fringed ritual garment), bless bread with the Hebrew “hamotzi,” keep Shabbat and study the weekly Torah portion, though they are devout Christians, is new for me as well.

They define themselves as Christian Zionists. Not an official denomination, more a small, independent current on the margins. They have no church of their own. “But it’s growing,” said Zach Strain.

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When I ask Yoss, short for Yosef, Strain and Jedidiah Ellis why they wear blue Tzitzit attached to their belts, Yoss quotes the Book of Numbers, Chapter 15, Verse 39. “That’s the longest I’ve heard him speak since they got here,” Haim Mann jokes.

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רותי וחיים מן, בעלי החווה

Ruthy and Haim Mann, the ranch owners

(Photo: Alex Kolomoisky)

On a recent Monday morning, the small group of five men and three women is already at work. Bethany Strain and Lily Plucker haul wheelbarrows of stones, Lily’s three-month-old son, Jethro, strapped to her chest. Her husband, John Plucker, the group’s unofficial leader, builds the wooden ceiling of what will soon become a resilience and support center for soldiers coping with PTSD at the edge of the ranch.

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Yoss and Jedidiah work on the stone wall of the riding arena. Promise Strain washes laundry by hand facing the desert view. Eliora Ellis saws a wooden beam. Zach, who stands nearly 6-foot-7, reinforces the stable fence. They work in near silence, focused, as if fulfilling a commandment.

By profession, Zach trains horses and riders for the film industry, primarily for Westerns, and has appeared in some of them himself. He worked on the TV series “Yellowstone.” When I try to draw him into Hollywood gossip about Kevin Costner, but since there is a biblical injunction against gossip, all I can get out of him is that the horses on the series were the finest and most expensive available. They are reserved, almost shy. They speak sparingly. They appear unaccustomed to social company. Montana is about 18 times the size of Israel with roughly one-tenth its population. The nearest neighbor can be miles away. In the photos they show me, each home looks like it could have stepped straight out of the cast of “Little House on the Prairie”, except for one detail: a giant Star of David mounted on the Strain family home.

All of them are related. Zach, Yoss and Promise Strain are siblings (the fourth brother, Ezekiel, left yesterday). Jedidiah and Eliora are married. Yoss is married to Bethany, John Plucker’s sister. Plucker is married to Lily. It is their last day in Israel, and they seem determined, more than anything, to make the most of every remaining moment. This is their last day, though not their first visit. For most of them, it is their fourth or fifth trip, and never a vacation. They come to work.

Ruthy and Haim Mann, the ranch owners, are Israeli cowboys in their own right. Boots, hats and wide brims included. Haim, a lawyer by training, also carries a handgun. They live in the settlement of Alon, part of a cluster of three Jewish communities northeast of Jerusalem, which includes mixed, religious and secular residents living side by side. “It works beautifully,” Haim says. The population is largely middle-class.

Indeed, although several flashpoints of the Israeli-Palestinian conflict, including Khan al-Ahmar, lie not far from here, this specific area, located in Area C of the West Bank, is quiet and calm. Not quite Montana, but they manage with what they have.

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רוכבים על רקע מרכז הטיפולים החדשרוכבים על רקע מרכז הטיפולים החדש

Riding against the backdrop of the new treatment center

(Photo: Alex Kolomoisky)

Both are remarried. Together they have two daughters, along with four children from Haim’s previous marriage and two from Ruthy’s, and they are grandparents to five grandchildren. Thirteen years ago, they founded a small therapeutic horse ranch. (“We’ve always loved horses,” they say). Ruthy handles treatment, working with teens with autism, motor and social challenges and trauma. Haim manages the horses. Five years ago, they were told to evacuate their original site. “We gave service to the whole community and got a punch in the stomach in return,” Ruthy said. With assistance from the Settlement Division, they relocated to the current hilltop. Haim closed his law office, Ruthy left her job at the Biblical Zoo in Jerusalem, and they committed fully to the ranch, which officially opened to the public about six months ago. Five dunams, 13 horses and a sweeping biblical landscape. Beyond routine therapy for local youth, the ranch increasingly served teens who had left the ultra-Orthodox community, including girls who were victims of sexual abuse, “even at ages 12 and 13”, sometimes within their own families.

About two years ago, they began hosting a joint Passover Seder for dozens of such teens. “The at-risk girls,” Ruthy says, “taught us a great deal about treating trauma.” That knowledge, regrettably, soon became urgently necessary. When war broke out after the October 7’s Hamas massacre, activity at the ranch halted. Ruthy began treating evacuees from southern Israel housed in Dead Sea hotels. “Everything there was terrible,” she says. At first, the therapy sessions were held in the hotels, without horses, using smaller animals instead. Over time, families began coming to the ranch to ride. “We started with 20 families. Within a month, 150 were coming,” she said.

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Soon after, soldiers began arriving, some physically wounded, others psychologically scarred. “It started with soldiers who rode with us as kids,” Haim said. “They enlisted, went to fight and were injured. They came back to us to rehabilitate, to regain control over their lives.”

The Manns speak about the female and male soldiers who came, about the visible and invisible wounds, about trauma and post-traumatic stress. Tears well up in their eyes more than once. In mine, too. The fact that I pushed the subject aside for months does not mean it disappeared. Suddenly, the stories from the war resurface. You can feel the weight pressing on your chest. The word got around. An injured friend brought another wounded friend to the ranch, “until we realized we needed to build something new here,” Haim says. The existing ranch could not meet the scale or the specific needs. The couple decided to establish a separate resilience center for soldiers, to be named after Omer Van Gelder, a former rider from the area who was killed in Gaza in June 2025. The center is steadily taking shape, John Plucker is currently standing on its roof, and they plan to launch a crowdfunding campaign soon to complete the project.

The need, they say, is immense while the supply is limited. Many soldiers from the West Bank have been killed or wounded, disproportionately to their share of the population. “But in all of the West Bank,” Ruthy says, “there isn’t a single ranch like this. There is a resilience center in Binyamin, but not everyone is suited to sitting in a closed room talking to a therapist about their feelings. It’s also a community that is less inclined to ask for help. Still, many people need precisely this kind of therapy, with horses, out in nature.”

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בונים תקרת עץ ביום האחרון בארץבונים תקרת עץ ביום האחרון בארץ

Building a wooden ceiling on their last day in Israel

(Photo: Alex Kolomoisky)

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Demand is surging. “We feel the shockwaves of the psychological injuries from the war starting to hit with tremendous force,” Ruthy said. “It’s not just ripples. It’s a tsunami.” Everything mental health experts warned about during the war, that once it ended and there was no longer anything to suppress or conserve strength for, a major wave of psychological casualties would follow, is unfolding before the Manns’ eyes. “You feel it everywhere,” Haim adds. “In rising divorce rates, in pent-up violence. We know that what isn’t treated today will worsen tomorrow. The country has to confront this by building more resilience centers, otherwise we’ll be carrying it for years. “And it’s not like the trauma of October 7 is going to disappear anytime soon. We’ll be living with it for years.”

“There are other injuries that aren’t being talked about enough,” Ruthy says. “For instance, girls who were already in very difficult circumstances before October 7 and had just started to rebuild their lives, only for the war to shift attention elsewhere and leave them sidelined.” There are also many patients with older wounds and traumas that resurfaced, but there isn’t enough time, enough therapists or enough resources to reach them.” The sound of a bell rings out to announce lunch. The group gathers in the ranch’s main building for a modest meal of white rice and a tough steak. They recite a blessing over the food and eat in silence.

Haim Mann says the connection with the Montana Cowboys began in November 2023, less than a month after the October 7 massacre, when a group of Montana ranchers arrived in Israel to help local farmers, more precisely, farmers in the West Bank. The initiative was organized by HaYovel, founded by the Waller family, themselves Christian Zionists, who came to Israel about 20 years ago, settled in the Har Bracha area and began bringing other Christian Zionist volunteers to work in the region.

Word of the group’s arrival reached Haim as well. “I wanted to thank them, in my name and on behalf of the Jewish people. I offered them a day of horseback riding in the area. They came here and fell in love. We fell in love with them, too.” The group stayed at the ranch for three months, building everything by hand. “They were like a miracle for us,” Haim says. “We didn’t have a dime.” This latest visit, about a month long, focused entirely on constructing the new center.

Zach first visited Israel in 2014. This is his fourth trip. “It was very important for me to come help, to build and strengthen Israel,” he said. “Israel is the light of the world, maybe even the foundation of the world. I don’t know how to explain it, but when you’re here, you feel it.”

What does it mean to be a Christian Zionist?
“Some people call us that. Maybe it’s accurate,” he said. “We don’t have definitions.”

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How do you define yourself?
“We don’t spend much time defining it. We’re somewhat different. We just go by the Bible. We’re not part of any church. It’s not really a movement. Nobody knows us. It started with our family, and people joined.”

I watch a video of a Shabbat meal at the family home in Montana: Kiddush over wine, Sabbath songs and a reading of the weekly Torah portion. They look a bit like the Amish. “We are not evangelicals”, he insisted. “We’re not trying to convert anyone. And I don’t even understand why I would need to convert anyone.” “We’re not evangelicals,” Bethany says as well, “but we’re fairly close to that.”

Zach, have you noticed a change in Israel compared to your previous visits?
“Since the war, I think people have come to see more clearly how deep and destructive evil can be. In America, it’s created a serious division. Many think Israel shouldn’t exist. That’s what’s being taught in schools today. They don’t know what’s happening here.”

That’s what they’re teaching in schools?
“We didn’t attend public schools,” he says. “Our parents pulled us out because they were teaching us lies.”

Zach also refers to John Plucker as the group’s unofficial leader. “I go where John tells me,” he explains. The fact that Plucker is 12 years younger does not seem to matter. The Strain and Plucker families have known each other for years and are closely connected. Two of the Plucker daughters are married to two of the Strain sons.

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“‘Unofficial leader’ is a good definition,” agrees John Plucker, 27.

Are you really a cowboy?
“Yes. That’s how I grew up, on a traditional ranch with horses and cattle and everything. Today I’m an independent contractor and run a construction company. There’s not much money in ranching. It’s more of a lifestyle. I want to work a few more years and buy some land.”

Plucker does not define himself as a Christian Zionist. “I’m just a regular Christian,” he says. “But I see Israel the same way they do, and we believe the same things, so maybe I am a Christian Zionist? I don’t know. Honestly, I don’t really care.”

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הבוקרים בשדות מונטנההבוקרים בשדות מונטנה

The cowboys in Montana fields

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(Photo: Courtesy)

So why did you come?
“The Strains have been coming for years, and they convinced me. We all love Israel very much. The first time I was here was after COVID, and it was incredible. HaYovel brought us. They believe God gave this place to the Jewish people. Here I learned a lot about redemption. You can see it happening in real time. It’s powerful. You learn much more here than just by reading the Bible.”

The last time he came was in November 2023. “They brought us to work in Shiloh, harvesting olives. The moment I came to the ranch, I fell in love, even though there was nothing here yet. My background is ranching and horses, so this suited me much more than picking olives, which is a pretty strange job, honestly. We didn’t hesitate to return, even though our baby had just been born.

“I see what they’re doing here with the young men and women who come for therapy. They give them purpose. They turn something negative into positive. It really brings redemption into people’s lives. I’m glad to be part of it. I already want to come back again. Staying in one place for a long time, building relationships, that’s a blessing.”

When I ask about politics, the group responds with puzzled looks, as if they had never even heard of Trump.“We’re simple ranchers,” Plucker said. “These things don’t interest us. We’re aligned with conservative views, but I don’t really understand politics. I’m here for the Jewish people. Politics may be important here, but not for us.”

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By midday, the horses are released ahead of the afternoon’s therapy sessions. I meet Aviv, Sinai, Negev, Pele, Pazit, Milky and Moshe, a large black horse. I do not ride, but standing beside them, something shifts. A horse is a wonder. Sinai, a horse, or perhaps a mare, I didn’t check, walks toward me and looks straight into my soul. We share a quiet moment.

What is it about horses?
“A horse is a spiritual animal,” Ruthy said from atop Negev. “Every encounter with a horse exposes the soul. The horse immediately senses your frequency. If you’re tense, it’s tense. If you’re calm, it’s calm.”

“What allowed horses to survive for 80 million years is extreme sensitivity,” Haim said. “They are alert to fear, to anxiety. They feel your heartbeat, your breathing. A horse is a perfect mirror for someone living with PTSD. When a person jumps at the sound of a motorcycle and shifts into survival mode, the horse shifts just as quickly. And when you calm down, the horse calms down with you. It forces you to lead, not with force, but with quiet confidence.”

Ruthy sees symbolism as well. “A horse is an open, unburdened space. The entire archetype of the horse is about strength and success, getting back on the horse, being on top of things. That’s also our therapeutic philosophy: to reconnect with that life force, to climb back into the saddle even after the hardest falls. It restores a sense of control to people who have lost all control over their lives.”





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Evacuation orders issued as 5,000-acre wildfire burns near Roundup, Montana

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Evacuation orders issued as 5,000-acre wildfire burns near Roundup, Montana



The Rehder Creek Fire is burning 16 miles southeast of Roundup has grown to about 5,000 acres, prompting evacuation orders for residents in the Bruner Mountain Area/Subdivision.

The fire started Feb. 26, the cause is unknown and containment was at 0%.

Evacuation orders are in effect for all residents in the Bruner Mountain Area/Subdivision. The Musselshell County Sheriff’s Office is coordinating the evacuation orders, and 911 reverse calls have been sent out to advise people in the area.

A shelter is opening at the Roundup Community Center. Residents were told to contact Musselshell County DES for further information.

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Firefighter and public safety remain the top priority. The public is asked to avoid the Fattig Creek and Rehder Road area so emergency personnel can safely and effectively perform their work.

Fire resources assigned to the incident include 40 total personnel, 11 engines, one Type 2 helicopter, three tenders and two dozers.



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February 26 recap: Missoula and Western Montana news you may have missed today

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February 26 recap: Missoula and Western Montana news you may have missed today





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