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Montana approaches end of Medicaid redetermination process

Montana DPHHS
Posted at 7:25 PM, Mar 12, 2024

HELENA — Almost a year after it began, Montana’s Medicaid redetermination process is approaching its end.

At a meeting of the Montana Legislature’s Children, Families, Health and Human Services Interim Committee Tuesday, leaders with the Montana Department of Public Health and Human Services told lawmakers they’re now processing eligibility reviews on the last batch of Medicaid recipients.

Every state in the country has had to recheck that everyone on their Medicaid programs remains eligible, after the end of a federal directive that let people stay enrolled without having their eligibility reconfirmed during the COVID emergency.

DPHHS spread its more than 300,000 enrolled recipients out over ten months, starting last April. The last group of cases was opened in January.

DPHHS Director Charlie Brereton told the committee that, on March 1 – after a 60-day cycle – the department made its last “procedural disenrollments,” meaning members who lost coverage because they didn’t submit the required information to renew, rather than because they were found to be ineligible.

According to the department’s online Medicaid redetermination dashboard, last updated Feb. 23, more than 127,000 individuals have lost Medicaid or Healthy Montana Kids coverage during the redetermination process. More than 81,000 of them – almost two-thirds – were removed because they failed to provide requested information.

Brereton noted that the department began by handling cases they thought were more likely to be ineligible – particularly because their income might have risen out of the qualifying range. He pointed to data showing the rates of procedural disenrollments fell in later months and the number of automatic renewals rose.

During Tuesday’s meeting, DPHHS also delivered more detailed data to the committee, which had asked for specifics on those who’ve lost coverage, organized by factors like age and tribal status.

Brereton said, based on February data, 44% of all individuals who went through the redetermination process had their coverage renewed, and 40% lost coverage. For children, 50% were renewed and 35% were not.

In both groups, the remaining roughly 15% of cases are still pending. Brereton said Medicaid members can continue to have their services reimbursed while their redetermination is pending.

“If a client has returned the necessary information to the department and we're in communication with the client, we're trying to verify something, we're not quite sure that we have what we need to make an accurate eligibility determination, we do keep that Medicaid case open,” he said.

Brereton said the department is working to clear its backlog of cases, including by trying to redirect cases from overloaded offices to ones that have more capacity. He said many of the ones they are still working on are particularly complex.

“Those cases are requiring a lot of engagement with authorized representatives and provider organizations, in addition to requiring verifications for those clients,” he said.

Rep. SJ Howell, D-Missoula, asked Brereton about how many redeterminations are taking longer than 45 days – a benchmark federal regulators warned the state about meeting in letters last year. Brereton said, while most of these cases must be processed in 45 days, certain cases have a deadline of 90 days instead. He said the department will work on breaking those two types of cases out, but there is not an easy way for them to distinguish that data.

Brereton again said Tuesday that any Montanans who lost Medicaid coverage but believe they should still be eligible are able to reapply at any time.