How ending premiums could threaten Medicaid expansion in Montana

Dan Gorenstein and Andrea Perdomo – Tradeoffs

Montana Republican Representative Ed Battery was a key player in expanding the state’s Medicaid program under the Affordable Care Act.

Now, he worries that a policy change by the Biden administration could mean, within a few years, the end of an expansion that currently provides more than 100,000 low-income Montana residents with access to health insurance.

“I am very concerned about the risk of losing the program,” said Patri.

Patri’s concern is centered around message Montana obtained from the Centers for Medicare and Medicaid Services late last year that by the end of 2022, the state should Stop collecting monthly payments For people on Medicaid. Arkansas received similar message.

Montana is one of 38 states and Washington, D.C., that allows childless adults who make up 133 percent of the federal poverty level to enroll in Medicaid, the interstate and federal program that provides health insurance to nearly 90 million people, most of whom are low income people nationwide.

As part of this expansion, five states – Montana, Arkansas, IndianaIowa and Michigan — They got special permission from the Obama administration to charge monthly Medicaid fees, something normally prohibited by federal law.

Conservative lawmakers in those states argued that getting people to pay premiums would help prepare beneficiaries to buy private insurance after they leave the program and give them “power in the game.” A popular but contested idea That if people had to spend more of their own money on healthcare, they would be smarter consumers.

The Obama administration has accepted the idea of ​​premiums, in part to spur reluctant red states to expand their Medicaid programs under the president’s landmark Health Care Act. But the Biden administration changed course thanks to a Growing evidence base Offering premiums makes it difficult for people to access coverage.

While many celebrate the administration’s move to roll back insurance premiums, Leaders like Battery in conservative states frustrated.

“It is amazing to me that the Biden administration decided that it would not allow premiums at all,” Pottery said. “This has always been one of the cornerstones of the Medicaid Extension Program in Montana.”

Expanding Medicaid in Montana

Patrie spent day after day in 2015 meeting with the then government. Steve Bullock, a Democrat, is trying to strike a medical expansion deal that could win the support of skeptical Republicans in the state legislature.

“I left the room a few times and turned off the call to the governor,” Patri said. “It was just a very emotional and emotional process because we all wanted to get something done.”

For Pottery and his conservative colleagues, premiums should be part of the equation.

“We wanted there to be personal responsibility and that would include getting rewards for healthy behavior, and getting a good path out of poverty. We needed people to be able to pay the insurance premiums, and to have a good appearance in the game,” Patri said.

Bullock strongly opposed charging Medicaid recipients for coverage, but eventually agreed. The premium was set at 2 percent of family income. certain groups — including the sickest, the poorest, and those who live in areas where there aren’t many providers — are exempt, and only people with incomes between 100 percent and 138 percent of the federal poverty level can be dropped for non-payment.

More than 100,000 people—about 10 percent of Montana’s population—are currently enrolled in a Medicaid expansion. 2021 University of Montana Report It found that Medicaid expansion in Montana helped more people get Medicare, created thousands of new jobs, and generated about $650 million in economic activity in the state each year. It also found that 40 percent of the $80 million the country spends on expansion annually is offset by lower health care costs and increased economic activity.

Meanwhile, state records show that at least 7,000 people have been kicked off Medicaid rolls for failing to pay their premiums — about 200 to 300 people each month.

“That’s a pretty big percentage,” said Heather O’Loughlin, co-director of the nonpartisan Montana Center on Budget and Policy.

The road ahead

In its letter asking Montana to phase out its premiums, CMS cited several studies on the impact of Medicaid premiums, including Study 2020 That included Montana and found that premiums likely kept enrollment rates lower, and prevented people from staying in the program for long — even people who were exempt from paying.

The CMS letter also cited research that showed premiums can exacerbate health inequalities by disproportionately affecting premiums. black And the low income beneficiaries.

said Kate Bradley, principal investigator with the policy research organization Mathematica who helped lead the 2020 study.

The Trump administration has approved three other states — Arizona, Georgia and Wisconsin — to impose premiums, though Arizona and Georgia have never implemented them. Arizona removed premiums from its plan in 2020, the Biden administration Withdraw At the same time, the Georgia authority asked Montana and Arkansas to end their programs. Wisconsin, which has not expanded Medicaid, briefly imposed premiums before pausing due to COVID.

The Biden administration has yet to take action on other states that are currently allowed to charge premiums, but a CMS spokesperson said the agency will consider the same research when reevaluating that state’s premium plans in the coming years.

Pottery said he doesn’t like seeing anyone lose coverage, but he generally feels the program has met its goals of improving health and the state’s economy. He worries that without the ability to collect premiums, Montana governors could refuse to re-expand Medicaid in 2025, when the deal Patrie helped orchestrate expires.

“I’ve personally dealt a lot with people whose lives were saved because they got health care or had access to addiction treatment,” Pottery said. “It would be hard to look at these people if I weren’t in favor of moving the program forward somehow, but I don’t know. I’m torn. I’m distracted.”

This story is from the Health Politics podcast Tradeoffspartner Side effects of public media. Dan Gorenstein is the Executive Editor of Tradeoffs, and Andrea Perdomo is a reporter/producer for the show, who runs a copy of This story On March 17th.