What Montana’s mass Medicaid reviews mean for you

For the first time in three years, since the early days of the coronavirus pandemic, federal health officials are allowing Montana and other states to reevaluate residents’ Medicaid eligibility and remove ineligible people from the public health insurance program. The process — which began in April and is slated to end in January 2024 — is expected to shrink Montana’s current pool of 324,125 people who receive health coverage through Medicaid, either because recipients are no longer eligible for the program or because of missed deadlines and administrative hurdles. 

How does the so-called Medicaid unwinding work? What are the rules and timelines? Montana Free Press put together this guide to help readers navigate the next several months.

WHOSE MEDICAID ENROLLMENT IS THE STATE REVIEWING? 

According to the Montana Department of Public Health and Human Services, which runs the state program, everyone who currently receives health insurance through Medicaid will eventually be reviewed for eligibility. That includes people who are eligible because of their income level, those who are aged, blind or disabled, and families whose children are covered through Healthy Montana Kids. 

Participants will be evaluated using the “autorenewal” process — that means the state checks a person’s name, citizenship, date of birth, place of residency and certain types of income. If the state cannot confirm eligibility through the autorenewal process, participants will be vetted using other information and databases, including Social Security Administration information, Social Security Income (SSI), child support payment records, vehicle ownership information, death records, and unemployment insurance income. Keep reading for more information. 

HOW WILL I FIND OUT WHEN MY ELIGIBILITY IS BEING REVIEWED? 

Generally, the state health department has put people whose income qualifies them for Medicaid first in line. Over the coming months, other groups will be evaluated, such as people who are aged, blind or disabled. 

If you would like to check what month your eligibility will be decided and sign up to receive notices from the state via email instead of physical mail, you can create an account at apply.mt.gov. 

Olivia Riutta, the director of the health coverage program Cover Montana, said participants should expect to start receiving communication about Medicaid the month prior to what is listed on their account. 

“If somebody is hearing about the unwinding or changes to Medicaid and Healthy Montana Kids, there are ways to prepare,” Riutta said. “Even if their renewal month is months away.”

WHO WILL BE CONTACTING ME? 

Official communication about Medicaid eligibility will come through the Department of Public Health and Human Services’ Office of Public Assistance. For the first five months of the redetermination process, the health department is contracting with a third-party company, the Public Consulting Group, to help work through renewals. Even if a case is handled by PCG, direct communication will continue to come to Medicaid enrollees through the state health department, agency spokesperson Jon Ebelt said Thursday.

Based on reports coming from other states, the state health department has warned Medicaid participants to be alert for scams about their eligibility. Any messages requesting payment to renew or apply for Medicaid shouldn’t be trusted, the department says, and should be reported to the Office of Consumer Protection at 1-800-481-6896. 

HOW CAN I UPDATE MY INFORMATION AND SUBMIT A RENEWAL PACKET? 

If you’ve moved or had a change in your household size or income, you can report that information to the state health department by filling out this form. Outdated contact information means communication about eligibility will likely go to the wrong place — Riutta and other health coverage advocates stressed the importance of making sure your information is current.

The state health department has said that anyone whose eligibility cannot be determined through the autorenewal process will be asked to fill out a packet of additional information and return it within 30 days. The department says that failure to submit that information by the deadline will result in an end of Medicaid coverage. 

If your address is up to date, you will receive that packet in the mail. The packet can also be completed online by creating an account with apply.mt.gov, over the phone by calling the health department at 1-888-706-1535, faxing the information to 1-877-418-4533, or mailing the packet to this address:

DPHHS
PO Box 202925
Helena, MT 59620-2925

You can also find help completing your renewal packet in-person at your closest Office of Public Assistance. Those office locations can be found at this website.

WHO ELSE CAN I CALL FOR HELP SUBMITTING MY ELIGIBILITY PACKET? 

If you’re confused, overwhelmed or hitting a dead end, Cover Montana [an arm of the Montana Primary Care Association] has set up a help line you can call at 1-844-682-6837. The group also has an online tool to help you find nearby resources based on your zip code, including health care clinics where Riutta says you can find a certified application counselor. (MTFP recommends searching for locations within at least a 50-mile radius.) 

“Sometimes that’s our navigators, sometimes that’s a certified application counselor down the street at a local hospital or a local clinic. But you can see kind of where folks are located within your community,” Riutta said.

The health department is also directing applicants to seek help through their Office of Public Assistance or through the state’s helpline (also listed above): 1-888-706-1535. 

WHAT OTHER DEADLINES SHOULD I KNOW ABOUT? 

When mailing or submitting your renewal packet, Riutta said, it’s important to make sure your materials will be received by 5 p.m. on the listed day — typically the 10th day of the month after you received your packet in the mail. (For example: A packet mailed on May 10 would need to be received — not just postmarked — by June 10.]

Participants who are worried they’re not going to make the deadline, Riutta said, should return their packet as soon as possible to minimize or avoid any lapses in insurance coverage. 

“The department is going to start that process of closing out that case. However, if the department receives the renewal packet by the end of the month … it would still get processed, and someone might not, if they’re determined eligible, have a gap in coverage,” Riutta said. 

If a participant is determined ineligible, the department is required to provide at least 10 days notice that their coverage is ending. That change would be effective beginning on the first day of the following month. 

IF I AM REMOVED FROM THE MEDICAID PROGRAM, CAN I APPEAL?

Yes. Appeals to Medicaid eligibility decisions will be directed to the DPHHS Office of Administrative Hearings. You can find out more about the administrative hearing process on the state health department’s website, or through this resource from the nonprofit Montana Legal Services Association. 

Ebelt, the health department spokesperson, said the agency will reverse any incorrect denials to avoid gaps in coverage. 

“If someone’s eligibility has been determined to have been closed in error, Medicaid coverage will pay retroactive back to when it was closed, so there would be no gap in coverage,” Ebelt said. 

WHAT ARE OTHER OPTIONS FOR HEALTH INSURANCE COVERAGE? 

If you are found ineligible for Medicaid coverage, Cover Montana can help you navigate other options. Many Montanans may have untapped health insurance benefits through their employer, be eligible for Medicare, or can join the plans of a spouse or parent.

You can also purchase a coverage plan through the federal Health Insurance Marketplace. Changes to the Affordable Care Act have made it easier to find reduced premiums based on income, age and household size. An online calculator available through Cover Montana can help you estimate what you might qualify for.   

HOW MANY PEOPLE IN MONTANA HAVE LOST MEDICAID COVERAGE SINCE THE ELIGIBILITY CHECKS RESTARTED? 

The state health department declined to tell MTFP how many people have been determined ineligible for Medicaid coverage throughout April, May and June. The state’s publicly available dashboard, last updated on May 18, said that out of 32,143 people contacted by the department in April, 6,262, or 19%, had so far been found eligible to maintain coverage, 35% of participants were still being reviewed, and 45% had not yet returned renewal packets. 

Ebelt told MTFP that former Medicaid recipients have appealed the department’s eligibility decisions since reviews began in April, but did not provide a specific number before publication. 

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