Medicaid Changes Spark Legislative, Provider Concern

Changes to Medicaid rules and the cancellation of a planned healthcare provider reimbursement increase have led to concern among both providers and patients as Montana faces a deficit in the human services division.

After voting to increase Medicaid spending last session, the state is having to draw back on a planned 3 percent provider rate increase.

Large-scale federal changes are also affecting Montanans. Last year, Congress pushed through — and President Donald Trump signed — a reconciliation bill, known as the “One Big, Beautiful Bill.” That bill implemented new work requirements for accessing Medicaid, which all states will implement by the end of the year.

There’s also a list of exceptions to who has to complete the work requirement.

‘Prepared for this transition’ Montana is moving on the new, federally-mandated work requirements six months early — to start on July 1 — which is the beginning of the state’s fiscal year.

“The department is fully prepared for this transition, with trained staff, clear exemption processes, and systems ready to support members,” said Charlie Brereton, the Montana Department of Public Health and Human Services director, in a press release. “We are focused on helping eligible Montanans keep their coverage while successfully meeting these new requirements.”

The release from the state went on to say the requirements are “intended to promote self-sufficiency, increase workforce participation, and ensure responsible use of public resources, while preserving coverage for those who qualify.”

But the changes are already impacting some across the state, including Celeste Thompson, a caregiver with SEIU 775.

Thompson said Trump’s bill ended up with her having to go off of Medicaid because of the work requirements. Her husband receives disability assistance and the work requirements for Medicaid are 20 hours per week and 80 over a month.

However, a spouse’s income is factored into standard disability payments, meaning if she worked more her husband could lose the disability assistance.

“We need his disability to make ends meet,” Thompson said.

She’s been a caregiver for nearly 25 years between two different companies, Thompson said this week, adding she’s trying to get back on Medicaid, but is unsure when that will happen.

“With all this going on, state and federal, it’s frustrating, it’s frustrating all over, and I’m frustrated about it,” Thompson said. “We need to try to elect the leaders that are going to work with us instead of against us.”

Looking to take action, some Montana organizations are planning Medicaid demonstrations at the capitol, including one on July 8, hosted by Catalyst Montana.

The new work requirements are adding administrative hurdles, said Dillon Sarb, a senior organizer with the organization, and pointed to the fact there’s other impacts, too.

“Coverage losses are a huge one that has downstream effects on how hospitals, particularly rural hospitals, will be impacted financially,” Sarb said. “I think the communication piece is certainly a part of all of this, too. People I talk with are very concerned about these new changes coming, and it’s unclear how and what they need to do to comply. That’s obviously a huge fear for folks.”

‘When there’s no new dollars’ Additionally, DPHHS has faced a massive budget shortfall that they’ve said they plan to address by canceling a 3 percent Medicaid provider rate increase for the coming fiscal year.

In order to address the shortfall, they created a supplemental budget request and are statutorily obligated to show their own cost-saving measures. One of those measures was not increasing the provider rate approved by the legislature.

DPHHS did not respond to Daily Montanan questions regarding provider rates or what benefit Montana receives by bringing on the work requirement deadline early.

DPHHS has blamed the Legislature for the shortfall, saying it warned the Legislature that its budget was too conservative.

Democrats last week gathered at the state Capitol to protest the cancellation of the provider rate increase and fight for access to Medicaid. Helena Rep. Mary Caferro called out Montana Gov. Greg Gianforte who she said “chooses to cut Medicaid,” which makes life “less affordable” for Montanans.

In a response to MTN News, the Governor’s office said it “will not apologize” for making “hard choices” to keep Medicaid stable. The statement went on to say the Legislature failed to properly fund the department.

“We slowly built our way to where we are today, with the expansion of Medicaid, with the historic investment in behavioral health, and the increase in the provider rates that began to get providers up to be competitive and be able to keep their doors open,” Caferro said. “Our priority is the people of Montana, the providers who provide the care for people who need health care, and of course, I am tired of having this conversation. I am so tired of governors getting into office and forgetting who elected them.”

Some providers, including Jason Cronk at Immanuel Living in Kalispell, are also expressing concern at the state of Medicaid in Montana.

Immanuel Living is a nonprofi t senior living facility, something of a rarity in Montana, Cronk said.

It’s given them some major advantages — namely, employees who believe in the group’s mission and stick around because of that — but the organization runs on a tight budget. They have a foundation and donors as well, which is hugely beneficial, he said.

Inflation, in particular, has made things more difficult, Cronk said, and they were depending on the provider rate increase.

“Most of Montana nursing homes are rural nursing homes that depend on Medicaid as their primary source of revenue, and that’s devastating when there’s no new dollars coming in July 1,” Cronk said in an interview this week.

Cronk’s worry is about the other nursing home and assisted living facilities that don’t have a strong mission and operate for-profit models. It’s going to be difficult to keep those small facilities going, he said, especially as Montana continues to get older at a rate that outpaces much of the rest of the country.

The state also reimburses at a lower rate compared to those that surround Montana.

“They’ve really given nursing homes the lowest priority in funding for the Medicaid program,” Cronk said. “They give prisons higher priority than they give Montana nursing homes.”