These are tough financial times for Americans. We certainly are feeling it here in Montana.
A trip to the grocery store costs significantly more than a couple of years ago and paying for gas to get there is maybe the most frustrating expense of all. Family vacations are out of the question for many and a trip to town for some of our more rural folks might be unaffordable. People work hard and their money is not going as far as it should. Things will get even tougher on many working people starting July 1 as accessing health care for the 80,000 folks who get insurance through Montana Medicaid will require additional burdens.
The federal government has mandated states adopt Medicaid work reporting requirements by Jan. 1, 2027, adding paperwork and logistical hurdles for our friends, family and neighbors who get healthcare coverage through Montana Medicaid. Montana has opted to be one of the first states through the door, starting those requirements six months before required and sending our residents, needlessly early, into a paperwork swamp that will leave many struggling to access the basic healthcare we all need.
The state’s decision could have devastating impacts. It’s a significant change as Medicaid expansion was adopted by the state legislature in 2015 and confirmed and extended last year by a bipartisan group of lawmakers. This coverage is for Montana residents who work but don’t make more than 138% of the federal poverty level, which amounts to less than $46,000 per year for a family of four. They cannot afford to purchase healthcare on their own and many are not even eligible to receive tax credits that make private healthcare more affordable. They often work seasonal jobs in agriculture or hospitality, food service or retail. Some hold multiple jobs to get by. They receive no cash benefit. Montana Medicaid simply provides access to the healthcare they need.
The problem is not that these folks do not work and so are unable to meet the requirements. The problem is, the systems and information required to prove that they work are exceedingly difficult — perhaps impossible — to navigate, meaning many will lose the coverage for which they are eligible.
There is no evidence that work requirements lead to more people working. The vast majority of Medicaid expansion beneficiaries work hard, need care and will still end up in a doctor’s office at some point if left uncovered, but in far worse health. Research shows that Medicaid expansion leads to earlier cancer diagnosis, better outcomes and less healthcare expense for all.
With Montana racing into this bad policy, we are left with many troubling questions about how the process will function. Will the reporting systems work? Will they be clear? Will exemptions for those too sick to work be honored so that those dealing with treatment for diseases like cancer can maintain their care regimen and, ultimately, their lives? Or, like with Medicaid unwinding, will Montana’s systems once again fail those who need to maintain their health coverage the most?
When similar requirements were implemented years ago in Arkansas, before being struck down in court, tens of thousands of eligible residents lost coverage. Now, only Nebraska has gone out faster than Montana and it’s particularly telling that Arkansas — so eager previously — is waiting until the required date.
The Montana Department of Public Health and Human Services made this reckless choice and the governor is standing behind it. The results will now come, with real human consequences.
This cannot be a “set it and forget it” situation. The state’s responsibility must be to make sure that those eligible can reasonably gain and maintain access. Anything less would seem like those pushing these rules have less interest in the lives of working Montanans than they do in stripping away their healthcare.