As of July 1, Montanans on certain Medicaid programs will be required to work or volunteer 80 hours every month or file for an exemption. The state is among the first in the country to roll out work requirements under a federal law passed last year. But, officials haven't finished setting up everything they need to implement the new rules.
At a legislative hearing just a week before Medicaid work requirements were set to roll out, state health officials told lawmakers they still hadn’t finalized a list of medical exemptions. That list was published mere hours before the rules went into effect.
Other systems that would automatically check applications for exemptions aren’t set up and might not be running for months. That means enrollees will have to identify and fill out the paperwork to get those exemptions.
The state doesn’t plan to start kicking Montanans off Medicaid for noncompliance until October, but health providers and policy watchers are still worried.
Aaron Wernham with the Montana Healthcare Foundation is concerned the state won’t be able to work out kinks by October and wants to delay the rollout until January. That’s the federal deadline to implement the new rules.
“We were worried about chaos that could be generated by the state rushing. Given how little information the state has provided about what they’re doing, I’m much more worried about chaos,” Wernham said. “This feels chaotic and rushed.”
He said people will likely lose coverage because they’re confused and don’t fill out the right paperwork, not because they don’t qualify for an exemption.
Lawmakers expressed similar concerns. State health department director Charlie Brereton told them he doesn’t expect the state will have any problems tweaking its system as problems crop up.
“We are not planning on extending beyond that three-month hold-harmless period. That is something we’ve negotiated with CMS,” Brereton said. “They’ve been fully supportive of that. So, there are no plans to extend that period, to be clear.”
This monumental change is coming at a time when services that can help Montanans with the new paperwork are diminished. Cover Montana helps Montanans fill out Medicaid applications and renewal forms. But it lost federal funding earlier this year.
Director Tierney Queen-Stewart had roughly 18 staff.
“We had helped more than 50,000 times with requests for help with Medicaid,” Queen-Steward said.
Now, her staff consists of one full time worker that can only assist over the phone.
That means Montanans will largely rely on the state help line or public assistance offices. But those systems struggled to keep up when the state had to redetermine eligibility for all Medicaid enrollees after the pandemic. People were on hold for eight hours or more or calls were dropped. Others received their renewal paperwork after the deadline to file.
The state is hiring more workers to alleviate those issues. So far, it’s hired a little over half of the workers it says it’ll need to keep up.
Providers like Alluvion Health in Great Falls say they’re doing all they can to help patients. But they are also confused about what they will need to provide for things like medical exemptions because of the state’s expedited rollout.
“The system is not set up appropriately,” said chief strategy officer Casey Schreiner. “The state isn’t manned to be able to handle some of this stuff at this point in time.”
Schreiner said his team will try its best to help as many Montanans as they can navigate the changes and maintain coverage.
