Montana's Medicaid disenrollment is even a bigger catastrophe than previously reported – Daily Montanan

You wouldn’t believe how many different ways I tried to begin this column trying to find the perfect analogy or phrase to sum up just how badly the Gianforte administration has handled Medicaid in Montana.

Describing it as a dumpster fire, for example, would imply that a raging fire is contained in a small space. More importantly, it says nothing about the real Montanans who lives are upended by what is a political decision that has more to do with Republicans trying to out-Republican each other than it does with being earnestly concerned about fraud, the reason given for making Medicaid enrollment so severe in Montana.

Our ideologue governor has taken a system that was often cited as a model of how the Medicaid expansion could work and dismantled it, hurting Montanans who struggle, hospitals and healthcare professionals, and reneging on a financial set-up so sweet that it should make anyone with a little business acumen scratch their head.

Let’s begin with the basics: After the COVID-19 pandemic, everyone, including the federal government, knew that Medicaid rolls would need to be trimmed, and expected that many who were previously eligible would drop because they had either restarted employment or found a new job.

But Montana’s number of people dropped from the public insurance enrollment has literally been extraordinary. As it stands right now, 10% of the state’s entire population has been dropped – a sheer number that should raise eyebrows.

The Gianforte administration in its zeal to attack a successful government program that has meant better health for residents as well as more stability for our stretched rural-centered healthcare, has also thumbed their noses at a deal that costs the state just a fraction of what it could be spending. For every dime the state contributes toward Medicaid, Montana receives 90 cents from the federal government. Virtually no other state gets a deal quite this sweet, and if the Gianforte administration had half of the business acumen it touts, it would be doing everything it could to take advantage of this deal.

Who wouldn’t take a deal that guaranteed giving us nine times the money we invest?

Setting aside the most important point that seems to get lost in every Medicaid policy discussion: The effect of Medicaid expansion in Montana has meant that residents are living healthier lives because they have insurance, and Medicaid has also meant a financial lifeline to hospitals who were strapped with a growing number of uninsured and underinsured patients.

These rural healthcare facilities in Montana are often the economic backbones of smaller communities, often being the largest private employer in rural communities. What the Gianforte administration has done, with the legislature’s approval, is threaten the viability of rural healthcare in the state by booting residents off the Medicaid rolls, leaving those already strapped healthcare organizations to absorb the loss. The lawmakers decided that Montana should “redetermine” eligibility more quickly, meaning there’s more churn to Medicaid, meaning more instability for residents and the healthcare they rely upon. Look no farther than what has happened to our rural nursing homes to see the results of not funding healthcare adequately.

But don’t take my word for it, look at the statistics. Montana has been booting residents from the Medicaid roll at a clip that is around three times more than average nationally. What makes that fact even more troubling is the inconsistent, if not conflicting, reports lawmakers have gotten from the Department of Public Health and Human Services, whose answers have more closely resembled a choose-your-own-adventure book than transparency.

You may recall that as Montana started its Medicaid purge, the Biden administration placed the state on notice that it was booting residents so quickly while at the same time seeming to ignore that the state had created a situation that was nearly impossible for those same residents to talk to a live person to get help.

Keep in mind that Gianforte himself made close to a billion dollars by creating a technology company that served to create customer service call centers. So much, apparently, for running the state like a business. This should have been something that Gianforte could have solved himself.

As lawmakers from both parties expressed concern that Montana was booting too many residents too quickly off Medicaid, DPHHS director Charlie Brereton quipped that the state could actually speed up the process – a sort of veiled threat that lawmakers should step lightly.

Yet last week, when lawmakers continued to press for answers about why so many people were losing insurance, as well as other related matters, Brereton told legislators that his staff were so taxed, and spread so thin that they simply don’t have time to answer their questions – the same people who are charged with making policy decisions about this essential care.

So, I’ll ask: Which is it, Mr. Brereton? Is it that your staff could boot Montana residents even more quickly from health insurance that they need, or is it that you can’t even provide answers because your staff is so overworked?

An equally plausible answer is that the administration could start bumping off residents from Medicaid more quickly and won’t answer the lawmakers’ questions because the state is carrying out a political decision that has little to do with ensuring Montanans’ health, making a sound financial decision or worrying about the economic health or rural Montana.

Let me put it bluntly, though – in terms that would normally be hyperbole, but, in this case, are literal.

When people don’t have insurance, they suffer more and die sooner.

When rural healthcare facilities see a rise in uncompensated, uninsured patients, they close.

When lawmakers can’t get answers from their partners in government, public trust is eroded and government moves from function to dysfunction.

Maybe the Gianforte administration can help me: How is any of this an example of good government?