Montana
Procedural barriers complicate Medicaid enrollment for the unhoused
On a cold February morning at the Flathead Warming Center in Kalispell, shelter guests got ready for the day, eating breakfast, or figuring out if the bus was running on time.
Tashya Evans was in the parking lot smoking a cigarette while she waited for help with her Medicaid application.
Evans is one of about 120,000 Montanans who lost Medicaid as the state re-evaluated everyone’s eligibility. That number is still growing as the state releases more data.
About two-thirds of those who were kicked off state Medicaid rolls lost it for technical reasons like incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates nationwide, according to a Kaiser Family Foundation analysis.
Even unsheltered people like Evans, who still qualify, are losing their health insurance. That’s despite the state saying publicly it would use datasets like social security and disability to automatically renew people who likely still qualify for Medicaid.
Evans said she lost coverage in September because she didn’t receive paperwork as she moved from Great Falls.
That’s forcing her to forgo her blood pressure medication and pause dental work. She thinks her blood pressure has been ok, but waiting for the dentist has been hard.
“The teeth broke off. My gums hurt. There’s sometimes where I’m not feeling good and I don’t want to eat,” she said.
She sat down in a spare shelter office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population in the Flathead Valley.
Evans recounted all the struggles she’s had.
She tried asking for help at the local state public assistance office. She said staff there don’t have time to answer all her questions about which forms she needs to fill out or walk through the paperwork with her. She tried the state help line, but she couldn’t get through.
“You just get to the point where you’re like, ‘I’m frustrated right now. I have other things that are more important, so let’s not deal with it,’” she said.
Evans said she needs to spend her time looking for a job, finding her next meal and a place to sleep. Sitting on the phone most of the day isn’t feasible.
There’s no public data on how many unhoused people in Montana, or nationwide, have lost Medicaid, but homeless service providers and experts say it’s a big problem.
Montana health officials said they provided training to prepare homeless service providers.
State health department Director Charlie Brereton also resisted calls from Democratic state lawmakers to pause the redetermination process.
“I’m confident in our redetermination process,” Brereton told lawmakers. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.”
Redetermination went on as planned, ending in January, four months ahead of the federal deadline.
Those helping unsheltered people who have lost coverage said they have spent much of their time trying to help people get in touch with the state Medicaid office to provide them with the correct information.
Sorting through paperwork mistakes has also been a headache, said Crystal Baker, a case manager at HRDC, the homeless shelter in Bozeman.
“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again. Now, they have to wait two to three months without insurance,” she said.
Federal health officials warned Montana and other conservative states that have been unenrolling high rates of people for technicalities. The agency also warned states for having unreasonable barriers to accessing assistance, such as long hold times on help lines. CMS said that it could force states to halt their process, but so far hasn’t done so.
However, experts said blue states are also kicking homeless people off their rolls and that the redetermination has been chaotic everywhere. Because of the barriers unsheltered people face, it’s easy for them to fall through the cracks.
“It doesn’t seem like such a big deal to fill out paperwork,” said Dr. Margot Kushel, a primary care provider and a homeless researcher at the University of California, San Francisco. “Put yourself in the position of an elder who’s experiencing homelessness and has lost their vision, who has no access to [a] computer, no access to [a] car, doesn’t have [a] cell phone.”
People can typically get retroactive coverage if they get back on Medicaid after they are kicked off.
Kushel said being without Medicaid for any period can be dangerous for the homeless community, which has high rates of chronic health conditions.
“Being out of your asthma medicine for three days can be life threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.
When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, said Kushel.
Evans, who was able to get help with her application, is likely to regain coverage.
Providers on the ground said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several call-backs from the state for one client. The state needed to interview him to make sure he still qualified, but the state never called back.
“He waited all-day long. It was so stressful for him that he just gave up,” she said.
That client ended up leaving the Bozeman area before she could convince him it was worth trying to regain Medicaid.
Baker worries his health will catch up with him before he decides to reapply to Medicaid.
Brian Miller won the Democratic primary Tuesday for the U.S. House seat in Montana’s eastern district.
The Associated Press called the race for Miller, an attorney in Helena, who fended off a challenge from state Sen. Jonathan Windy Boy, a longtime legislator from Box Elder, and Sam Lux, a farrier from Great Falls.
In the Republican and rural eastern district, any Democrat will be an underdog, and Miller will face off against incumbent Republican U.S. Rep. Troy Downing, who was unopposed Tuesday.
Libertarian Patrick McCracken is also running.
In the primary, Miller took 58% of the vote. Lux took 27% and Windy Boy took 16%, according to the Montana Secretary of State’s website.
In April, Windy Boy paused his campaign amid “serious sexual abuse” allegations raised by the Montana Democratic Party — but Windy Boy restarted his campaign and later called the allegations “political attacks.”
Miller is representing the victim of the alleged abuse and her mother, although he said he didn’t take on the role until after Windy Boy initially suspended his campaign.
The Western Montana Food and Farm Trail, a new agritourism initiative led by Farm Connect Montana, launches May 30, offering locals and visitors a new kind of food and farm adventure across Western Montana.
Running June 1 through October 31, the self-guided Trail spans more than 200 miles and features more than 100 farms, ranches, farmers markets, restaurants, breweries and food businesses across the Missoula, Bitterroot, Flathead and Mission Valleys. Along the way, participants are invited to meet growers and makers, taste what’s in season and experience the culture and care behind Western Montana’s local food community.
At the center of the experience is the passport-style Trail Field Guide, illustrated by Missoula-based artist Courtney Blazon. The guide features illustrated maps, curated itineraries, seasonal highlights and more than 100 local food destinations throughout the region. The guide also includes more than $130 in special offers from participating farms and businesses.
Participants can collect stamps at Trail stops along the way to qualify for prizes, giveaways, or simply as a way to document their journey. End-of-season prizes include raffles for three CSA memberships valued at over $600 each, as well as local food and farm gift certificates, product bundles and Courtney Blazon-designed market totes.
The Trail is a regional collaboration led by Farm Connect Montana in partnership with Land to Hand Montana, The O’Hara Commons and Sustainability Center and Abundant Montana, organizations working to strengthen local food systems across Western Montana. The project aims to support local farms and food businesses through expanded visibility and agritourism opportunities while reconnecting locals and visitors with the people, places and stories behind their food.
“In creating the Western Montana Food & Farm Trail, we hope to inspire both residents and travelers to discover the stories behind their food and connect with the people cultivating a more vibrant, resilient and locally rooted food community,” said Bonnie Buckingham, Executive Director of Farm Connect Montana. “Participation in the Trail is a win for everyone. It creates new opportunities for farms and local food businesses to reach wider audiences while encouraging participants to explore new places, support local producers and experience Western Montana in a more meaningful way.”
“Land to Hand is thrilled to partner with Farm Connect on the Food and Farm Trail to highlight the robust agricultural heritage of Western Montana,” said Gretchen Boyer, Executive Director of Land to Hand Montana. “This initiative is more than just a guide – it’s an invitation to celebrate and support the local farmers who nourish our communities every day. By connecting residents and visitors directly to the source, we’re strengthening our local food system and honoring the people and landscapes that sustain the Flathead Valley.”
To celebrate the launch, regional Trail launch parties will take place in Missoula, the Bitterroot Valley and the Flathead Valley throughout early June, featuring Field Guide distribution, local food vendors, giveaways and opportunities to learn more about the Trail.
Trail Field Guides ($10) will be available for purchase beginning May 30 both online and at participating businesses, farmers markets and community locations throughout the region. A full list of Field Guide purchase locations and details, as well as a digital map and Trail listings, special events and more information is available at farmconnectmontana.org/trail.
Funding for this project was made possible through the U.S. Department of Agriculture’s Agricultural Marketing Service.
Regional launch events
• Missoula Launch Party — LaLonde Ranch, Sun., June 7, 1-4 p.m.
• Bitterroot Launch Party — O’Hara Commons Market, Wed., June 10, 4-6 p.m.
• Flathead Launch Party — Backslope Brewing, Tue., June 16, 4-7:30 p.m.
An “I voted” sign points to a Vote Center on June 1 in Los Angeles.
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Six states — California, Iowa, Montana, New Jersey, South Dakota and New Mexico — hold elections on Tuesday. Most of the attention is on California and Iowa, where there are competitive primaries for governor. In both states, the Democratic Party also sees a road map to control of Congress in the fall.
In California’s unique primary system, voters send the top two vote-getters to November’s general election, regardless of candidates’ political parties. Democratic Gov. Gavin Newsom is term limited, and California voters will also pick who should move on to the general election in five new Democratic-leaning congressional districts.
In Iowa, Democratic voters will choose a candidate in a key Senate race — the Republican in the race is already the de facto nominee. In order to win a majority in the Senate, Democrats must pick up four seats, forcing the party to win in Republican-leaning states like Iowa. For governor, the race is the first good chance Democrats have to win the office in years, but Republicans still need to select their nominee.
Here are key races to follow:
Or skip to specific races:
California governor | California U.S. House | Iowa governor | Iowa U.S. Senate | New Jersey and Montana
You can also check out June 2 voter resources from the NPR network.
California decides top two gubernatorial contenders
It’s been a chaotic scramble to pick the next leader of the country’s largest state. After three prominent Democrats — former Vice President Kamala Harris, Sen. Alex Padilla and state Attorney General Rob Bonta — decided not to run, Democratic voters haven’t had a clear front-runner for the first time in decades. Voters have more than 60 candidates to choose from, but only a fraction of those are considered serious contenders. Only the top two vote-getters will move on to the general election in November.
California Democratic gubernatorial candidate Xavier Becerra hugs a supporter at the Long Beach Arena on May 31 in Long Beach, Calif.
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The race got a shakeup when former Democratic Rep. Eric Swalwell, the presumed favorite, dropped out of the race after he was accused of sexual misconduct by several women. Most recently, polls show the contest could be between two Democrats — the Health and Human Services secretary under former President Joe Biden, Xavier Becerra, and billionaire philanthropist Tom Steyer.
Before Becerra was appointed to Biden’s Cabinet, he served 12 terms in Congress and was elected as the California attorney general in 2016. He’s considered by many as the candidate with the strongest political background. Becerra’s pitch is that he is a proven leader who can hold his own and protect California from President Trump.
Steyer has forked over more than $213 million of his own fortune on the race and is also financially backed by Our Revolution, a group aligned with Sen. Bernie Sanders, I-Vt. Steyer’s platform is centered on taking a stand against special-interest groups in politics.
Polling just a few points behind Becerra and Steyer is Republican Steve Hilton. The former Fox News host was endorsed by President Trump in April, after which Riverside County Sheriff Chad Bianco, another Republican in the race, quickly dropped in the polls. Hilton’s platform focuses on increasing affordable housing supply for first-time homebuyers, bolstering tech industries and reviving California’s film industry.
Democratic gubernatorial candidate Tom Steyer speaks with students during a Get the Youth Vote with Bruin Democrats event at UCLA’s campus on June 1 in Los Angeles, Calif.
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The outcome of California’s new congressional districts
In response to Texas redrawing its congressional lines to create five Republican-leaning districts at the behest of President Trump, Californians approved Proposition 50 in November last year. The measure temporarily sidestepped the independent redistricting commission tasked with drawing nonpartisan influenced congressional boundaries, in favor of politically gerrymandered districts. That allowed state Democrats to redraw their map so five previously Republican-held districts now lean Democratic.
This has left those Republican incumbents figuring out their political futures. Rep. Ken Calvert, the longest-serving Republican from California, and Rep. Young Kim are running in the same district, for example, in a race that’s gotten quite heated.
Then there’s Rep. Kevin Kiley. After being drawn into a much more Democratic-leaning district, he decided to run in a new seat and announced he was leaving the Republican Party and running as an independent instead, though Kiley said would still caucus with the Republicans.
Because of California’s primary system, some of these more competitive seats are creating competitive primaries between Democrats, allowing primary voters to signal to the party what kinds of candidates speak to them most in places that have the most to lose — and gain.
Iowa’s GOP gubernatorial primary
Iowa Republican voters could decide the party’s nominee for governor in the state’s first open race for the office since 2011, as sitting Gov. Kim Reynolds opted not to run for reelection.
With five Republicans on Tuesday’s ballot, Rep. Randy Feenstra is the only one endorsed by Trump. The race will test whether Trump’s endorsement holds weight in a state where his approval rating has slipped over the economy and the war in Iran. Feenstra’s lead may be declining, as one recent poll shows political newcomer and Iowa businessman Zach Lahn could have a shot at winning the GOP primary.
There is a good chance, though, that Iowans won’t know the outcome of the race on Tuesday because a candidate must secure 35% of the vote to win outright. If no one clears that threshold, the nominee will be decided at a Republican convention where delegates — not primary voters — make the final choice.
But the Republican-backed candidate isn’t a shoo-in come November. Cook Political Report categorizes the governor’s race as a toss-up with a slight Republican advantage. Whatever Republican wins on Tuesday will face unopposed Democratic State Auditor Rob Sand in the general election. Sand is popular among voters and has, so far, outraised any other candidate for governor.
Democrats look to flip Iowa Senate seat
Democratic voters in Iowa will pick which candidate they think has the best shot at beating the Republican nominee for Senate, expected to be Trump-endorsed Rep. Ashley Hinson, on Tuesday. This is a seat that Democrats believe they have a shot at flipping come November. It’s part of a larger strategy of expanding their map — and winning in states currently held by Republican senators — if they want a chance to retake the Senate majority.
Iowa Democrats have a choice between state Rep. Josh Turek and state Sen. Zach Wahls. Both candidates are courting different Iowa voters, though. Turek is vying for the independent-leaning vote, while Wahls is hoping to gain the support from committed Democrats. Turek flipped a state House district held by a Republican, while Wahls represents a Senate district that is solidly blue. Both argue they are the candidate who has the right message to win in November.
And with three competitive congressional races on the ballot, some Democrats in the state are feeling like the road to a Democratic majority in Congress runs through Iowa.
Looking beyond Tuesday
New Jersey and Montana also have competitive races that could decide which party has control of Congress.
In New Jersey, all eyes are on Congressional District 7. Four Democrats are hoping to oust Republican Rep. Thomas Kean Jr. The sitting congressman has been notably absent from Washington for weeks due to what Kean cites as unspecified medical issues. He has missed more than 100 House votes since his last recorded vote on March 5.
Two races in Montana may be more competitive than originally expected with the last-minute announcements — shortly before the filing deadline — by Republicans, Sen. Steve Daines and Rep. Ryan Zinke, that neither would seek reelection.
While an open Senate seat does not make Montana, which has long been considered a Republican stronghold, necessarily competitive for Democrats, an independent candidate is outraising candidates in both major parties. Seth Bodnar, Iraq war veteran and former president of the University of Montana, is hoping voters will send him instead, mostly on the message that he won’t work for either party and is focused on changing the direction America is heading. In Bodnar’s case, he has enough voter signatures to land himself on the November ballot, but the Montana Secretary of State’s Office hasn’t yet certified those signatures.
Democrats are working to flip Montana’s 1st Congressional District as well. When Zinke announced he was retiring from Congress, it was seen as an opening for Democrats to compete. Now, four Democrats are angling for the open seat, including front-runner Sam Forstag, a smokejumper who is endorsed by popular progressive Rep. Alexandria Ocasio-Cortez, D-N.Y.
June 2 voter resources from the NPR Network
California | Iowa | Montana | New Jersey | New Mexico | South Dakota
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