Revisions Can’t Fix Montana Medicaid Proposal — Still Takes Coverage From Thousands

The sponsor of legislation in Montana to take Medicaid coverage away from people who don’t meet a work requirement, charge low-income adults high premiums, and make eligibility contingent on completing extra paperwork related to job readiness and health status — all of which would have caused up to 36,000 people to lose coverage — has implied that changes he’s made to the bill would somehow ease some of the restrictions. But the latest proposal instead broadens the scope of the administrative barriers. This proposal can’t be fixed: regardless of its structure, it would likely cause tens of thousands of Montanans to lose coverage.

The revised Montana proposal would likely cause coverage losses similar to or even higher than those of Arkansas, the first state with a Medicaid work requirement. That state ended coverage for more than 18,000 people — or about 23 percent of those subject to the work requirement — in the first seven months under the requirement, a number that far exceeds estimates of those who aren’t already working or exempt from the requirement. As in Arkansas, most Montana Medicaid beneficiaries either work or should qualify for exemptions from work requirements, but they would still face a significant risk of losing coverage, due to the additional paperwork and red tape, or their inability to meet and report the required hours each month, or the confusion that such requirements cause.

The Montana sponsor, Rep. Ed Buttrey, amended his draft proposal to require those subject to the requirement to report their working hours each quarter rather than each month. But his new proposal doesn’t envision that the state will use administrative data, as Arkansas does, to exempt individuals from the reporting requirement if they appear to be meeting or exempt from the work requirement. That means most Montana beneficiaries would have to report their hours or show they’re exempt.

Arkansas’ experience shows that this change is likely to sharply increase the number of people who lose coverage. The state’s use of administrative data has exempted more than 75 percent of beneficiaries from the reporting requirement. But of those required to report work activities, in the latest month of available data, about 87 percent either didn’t report or failed to report enough hours to maintain their coverage. Requiring all Montanans subject to the requirement to report their working hours would dramatically increase the number of people who are working but lose coverage due to unnecessary red tape.

Even if the state uses administrative data to exempt all those who appear to be meeting or exempt from the requirement (as Arkansas has done), tens of thousands would still lose coverage. That’s because the state won’t be able to determine exemptions automatically for large numbers of people, and so many people would still be at risk of losing coverage due to paperwork requirements. As we’ve written, policies that take coverage away from people who don’t meet a work requirement can’t be “fixed” — any work requirement will take coverage away from many people who are working, between jobs, or eligible for exemptions from the requirement.

In addition to those who will likely lose coverage due to reporting requirements, many won’t be able to meet the 80-hour-per-month work threshold because of seasonal employment or because they have chronic health conditions that are hard to manage. Other groups, such as American Indians, are disproportionately likely to be unemployed, in part because they’re likelier to live in areas with limited job opportunities. For those who are working, between jobs, or looking for a job, losing access to health coverage may make it even harder for them to work.

With all this in mind, a coalition of Montana health providers and business leaders are urging legislators “to continue Medicaid expansion without imposing unreasonable barriers to coverage.” They wrote, “Without health insurance, Montanans are more likely to seek the wrong care, at the wrong time and at the wrong place — with poorer outcomes and higher costs. . . . Coverage is the keystone to improving the health of our residents, increasing the efficiency of our health care system and decreasing costs for consumers, businesses and the state.”

If Montana policymakers want to help low-income adults find jobs and advance their careers, they should instead boost the state’s investment in its promising workforce promotion program, which links Medicaid beneficiaries with job training and other work-related services. Expanding workforce training would do much more to achieve these goals than taking coverage away from Medicaid beneficiaries.