In the People's Interest

Dr. Cora Neumann: Montana’s Mismanaged Medicaid Redetermination Hurts Our Communities and Our Economy

For those of us in the health field, we were unfortunately not surprised by last week’s report showing that Montana ranked second in the country for most children to have lost Medicaid coverage since redetermination began in April 2023. This crisis is a direct result of the Gianforte Administration’s mismanagement of our state’s healthcare. 

Since April 2023, over 134,000 Montanans have lost Medicaid coverage, with 41,000 cases still pending (Montana Budget and Policy Center). This isn’t just a number–it’s families like those we serve at the Native American Development Corporation and our Billings Urban Indian Health and Wellness Clinic, where 60% of our patients last month had lost their coverage. The families we serve, and Montanans across our state–many of whom are most in need of care–now avoid medical care, delay medication, and fear medical bills they can’t afford.

The most frustrating part? Many lost coverage due to a poorly managed system, riddled with administrative barriers, undelivered and unreturned paperwork, and a lack of clear communication. The burden placed on working families, the elderly, and those with disabilities is astronomical. Simply trying to understand your coverage status can lead to waiting for hours on hold, only to be disconnected. A recent report shows that 38% of cases over a recent 1-month period took more than 45 days to process (data accessed via DPHHS)–this is unacceptable. 

Kelli Whithorn, who shared her story with Montana Public Radio, lost coverage due to a mailed renewal sent to an outdated address. Now, she’s struggling with congestive heart failure and mounting medical bills.

This isn’t just an administrative failure; it’s a public health crisis. Montana’s childhood Medicaid enrollment dropped a staggering 27% in 2023. This hurts rural areas the hardest, where access to healthcare is already limited. Worse, it undermines the positive impact Medicaid expansion has had on our state.

Thanks to Medicaid expansion, and prior to redetermination, enrollees with mental health and chronic conditions visited emergency rooms less frequently. For example, there was a 7% decline in emergency department visits for diabetes patients over a 3-year period (Montana Healthcare Foundation). This highlights Medicaid’s role in promoting preventive care and reducing overall healthcare costs. Medicaid expansion has also been a lifeline for our most rural communities. Uncompensated care costs have dropped by 35% in these areas, and no rural hospitals have closed since expansion–a stark contrast to states that didn’t expand.

Medicaid isn’t just about healthcare; it’s about economic stability. The Montana Budget and Policy Center reports that 76% of Medicaid recipients are working or in school. Medicaid expansion in 2022 helped create and sustain over 7,500 new jobs, generated an estimated $475 million in new personal income, and fueled $775 million in economic activity.

The Gianforte Administration failed our state. And what’s worse, I fear this slow and error-prone redetermination process will be used to manipulate data to justify ending Medicaid expansion in 2025, harming the very Montanans it was designed to help.

We need immediate action. The state must improve outreach, simplify enrollment, and ensure all eligible Montanans, especially children, can access coverage.  Let’s call on our legislators to hold the Governor accountable and fix this broken system.

The upcoming legislative session is also hugely consequential: Medicaid expansion expires in June 2025. Failure to reauthorize would put an additional 100,000 Montanans at risk of losing their care. Just imagine. If elected to the State Senate, I will get right to work, in collaboration with my fellow legislators and the communities we serve, to restore enrollment numbers and to ensure the system works efficiently and fairly for everyone. 

I got into public health and public service due to my own family’s traumatic loss of my father due to lack of access to adequate rural healthcare. This is personal for me, as I know it is for so many Montanans. Join me in speaking up and pushing to fix our broken Medicaid enrollment system and in starting early (now) to advocate for the renewal of Medicaid expansion. The future health of our state is in our hands.

Cora Neumann is Chief Community Health Officer at the Native American Development Corporation, and is currently running for Senate District 30, which covers South Bozeman, Gallatin Gateway, Big Sky, and West Yellowstone.