Montana’s Medicaid redetermination process in the wake of the pandemic has left more than 150 residents at 18 nursing homes without coverage. As a result, delayed reimbursement payments have left those nursing homes short $2.3 million — so far, according to the Montana Health Care Association.

The state’s redetermination process has been underway since April and has left 120,000 Montanans without the coverage they once enjoyed. During the COVID-era, federal regulators suspended the need to verify certain individuals’ Medicaid eligibility, but that relaxation of rules expired last year.

Montana has disenrolled 57% of its prior Medicaid recipients during redeterminations — the second highest rate in the nation, behind only Arkansas, according to a KFF study. The same report showed that 77% of disenrollments were due to procedural reasons, with only the remaining 23% deemed ineligible for coverage. 

Providers, consumer advocates and lawmakers alike have called for more transparency in the redetermination process from the Montana government. It’s still unclear when the process will conclude, how many residents will return to coverage or when the delayed reimbursement payments will reach the affected nursing homes.

Similar issues have played out across the nation during the Medicaid unwinding period, though some states have been able to significantly reduce denials of coverage, thanks to policies and procedures such as automated renewal systems. Maine, for example, has disenrolled only 13% while Oregon, North Carolina, Virginia and Connecticut have all kept disenrollment rates at 20% or lower. 

Slow appeals delay funding

As in select other regions of the country, the process of returning eligible residents to Medicaid coverage has produced many delays, according to a report from the MHCA. When skilled nursing staff have attempted to assist residents with phone calls, they sometimes have been left on hold for hours. Applications to Medicaid also have been delayed, with some residents waiting months to be assigned a caseworker. 

The cost and time demands this process has placed on Montana’s nursing homes comes at a poor time for the sector. Despite a nearly 26% increase in Medicaid reimbursement rates for 2024 passed into law last year, state long-term care leaders say all-too-familiar problems of staffing availability and high contract labor costs are still outpacing long-term care revenues

Those revenues have been further cut into by delays resulting from the redetermination process. Meanwhile, bureaucratic red tape and roadblocks have made regaining coverage a significant challenge for residents and their families, according to Terry Minow, chair of the Montana senior advocate group Big Sky 55+. 

“After helping residents track down their most recent Social Security statement or last six months of bank statements, some caregivers find out that because they didn’t schedule an appointment, the resident has already been denied coverage,” she wrote in the Missoula Current.