Federal regulators flag concerns as Montana cuts Medicaid rolls

Federal regulators are urging Montana health officials to fix shortcomings in the state’s Medicaid redetermination process, expressing “concerns” that the state may be disenrolling people who are eligible for the public health insurance and creating barriers for others through long wait times at call centers and during the application process.

The state began reassessing the eligibility of the more than 320,000 people on Montana Medicaid in April with the lifting of the federally-designated COVID-19 public health emergency, which barred states from removing people from the program during the pandemic. The state has since reported removing 34,204 people from the rolls in April and May, roughly half of all people reviewed. Data for June is still pending.

In an August 9 letter addressed to Montana’s Medicaid Director Mike Randol, an official with the Centers for Medicare and Medicaid Services (CMS) said the state’s May data showed an average call center wait time of 42 minutes and an average call abandonment of 40%. Those metrics are among the worst in the country — only Missouri had a longer average wait time of 48 minutes and a slightly higher drop rate. Nevada had a dropped call rate of 56%.

Both of Montana’s call metrics have worsened since March and April when the state reported an average wait time of 37 minutes and 35% of calls abandoned.

The federal agency also flagged the 36% of Montanans reviewed in May who lost coverage because of procedural errors such as failing to return paperwork or submit all the required information. Many of those individuals, including children, could still be eligible for the health insurance program, the letter said.

“While CMS expects procedural terminations, a high rate of procedural terminations may indicate that beneficiaries may not be receiving notices, are unable to understand them, or are unable to submit their renewal through the required modalities,” the agency said.

The letter also indicated that 15% of the income-based applicants who recently applied for Medicaid took the state longer than 45 days to process, “exceeding the regulatory requirements.” The notice said that expeditious processing of new applications, including some who may be re-applying after realizing they lost coverage, was “imperative.”

Out of 50 states that received letters about their recent data, the news site Politico reported that thirty-six were notified of at least one concern about call center wait times, application processing, or procedural disenrollments. Only five states — Montana, Florida, Rhode Island, Alaska and New Mexico — were dinged for all three categories.

In response to a request for comment on the federal letter, Department of Public Health and Human Services spokesperson Jon Ebelt said Friday that the department has been trying to simplify the phone tree options at call centers, adjust staffing levels and modifying its call-back protocol to prioritize enrollees who are most at risk of losing coverage. The department will also be starting a public service announcement campaign “in the coming weeks” that Ebelt said would run through the duration of the redetermination process, slated to end in January 2024.

“CMS sent helpful feedback to states this week,” Ebelt said. “We continue to closely monitor, evaluate, and strengthen our Medicaid redetermination process with a laser focus on ensuring coverage for eligible Montanans.”

The health department in November awarded a more-than-$2.25 million contract to Public Consulting Group LLC, a private contractor, to boost staffing levels for processing Medicaid renewals. On its website, PCG said it has allocated 40 staff to the contract.

Asked how the recent disenrollment and call center data highlighted by CMS reflect Gov. Greg Gianforte’s stated commitment to “customer service” from state agencies, Deputy Communications Director Brooke Metrione said the governor “has full confidence in DPHHS as it undertakes the overdue Medicaid redetermination process, ensuring eligible Montanans maintain their coverage while guarding against fraud, waste, and abuse of taxpayer resources.”

In recent months, advocates for Medicaid enrollees and Democratic lawmakers have called on Gianforte and the health department to pause redeterminations until the state can resolve issues leading to high rates of procedural terminations. The Montana Budget and Policy Center and Montana Women Vote, groups that lobby on behalf of low-income Montanans, reiterated that stance in a July letter to CMS. The outreach recounted reports of long call center wait times, confusion about the process and sudden disenrollments.

“Given the serious and endemic nature of these issues, we believe that the large number of Montanans being disenrolled includes a high percentage of people who have not had a fair and timely redetermination process and who may still be eligible for coverage. We believe the state should consider pausing or slowing the rate of redetermination until these issues can be addressed,” the letter said. One of the signatories was Rep. SJ Howell, D-Missoula, who works as executive director of Montana Women Vote.

In addition to the 71,930 enrollees reevaluated in April and May, the department began reevaluating the eligibility of another 38,372 people in June, according to its public dashboard. About 21% of that group had had their coverage renewed as of the dashboard’s last update in mid-July. Other applications are still being processed and roughly 45% of people under review hadn’t responded to the department’s requests for information.

The department has said it plans to update the dashboard once a month.