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Montana Health Department Plans More Frequent Audits For Medicaid Eligibility

Eliza Wiley
Montana Free Press

Montana’s health department is finalizing a proposal to increase how often it audits people enrolled in the state’s coverage program for low-income adults. Health care providers and advocacy groups say some will unnecessarily lose their health coverage.

State health officials told lawmakers Tuesday they’re aiming to comply with legislative intent by changing the eligibility policy within the state’s Medicaid expansion program, which provides health coverage to nearly 10% of Montanans.

Last spring, lawmakers passed a budget bill ending 12-month continuous eligibility for Medicaid recipients. Continuous eligibility aims to reduce the number of people churning through the health coverage program, allowing them to stay on for a full year, regardless of changes to their income.

Montana is one of only two states that allows Medicaid recipients to remain eligible for the program for an entire year.

Adam Meier is director of the Montana Department of Public Health and Human Services.

“What we’re really doing here is changing back to the default of what Medicaid defines nationally as the standard for eligibility,” Meier says.

If the state’s proposal is approved by the federal government, the health department will be able to audit recipients’ eligibility more frequently and end benefits for recipients more often.

Health officials are also applying to end continuous eligibility for a program that covers low-income residents with severe, disabling mental illness.

Kristin Page-Nei with the American Cancer Society says this will make it more difficult for people to access the health coverage programs.

“There’s an assumption being made that recipients aren’t already in crisis. Whether it’s their mental health crisis, whether it’s a medical crisis. When they’re in crisis, they’re not paying attention to their mail, they’re just trying to survive.”

Groups like the Montana Primary Care Association and Montana Coalition Against Domestic and Sexual Violence also voiced opposition. They say eliminating continuous eligibility will create too high a barrier for vulnerable populations to access health care consistently.

Copyright 2021 Montana Public Radio. To see more, visit Montana Public Radio.

Shaylee is a UM Journalism School student. She reports and helps produce Montana Evening News on MTPR.