New Analysis: Up to 56,000 Low-Income Montanans Could Lose Health Coverage if State Imposes Medicaid and Other Work Requirements

As many as 50,000 to 56,000 low-income people in Montana could lose health coverage under a new bill (HB 658) introduced on March 12, 2019 to reauthorize Montana’s Medicaid expansion and impose new work and reporting requirements on Medicaid recipients. These findings are part of an updated analysis published on March 14, 2019 by researchers at George Washington University’s Milken Institute School of Public Health.

This new report updates a previous in-depth analysis (released on February 13, 2019) that looked at an early draft of the bill. HB 658 includes several relatively minor changes from the previous bill draft. This updated report takes those changes into account and adds an analysis on the potential impacts on the self-employed and newly proposed reporting requirements such as health risk assessments and employment readiness reports.

Key findings of the updated report include:

  • 29,000 to 38,000 enrollees could lose coverage due to work (or “community engagement”) requirements.
  • 14,000 to 17,000 of those remaining could potentially lose coverage due to new reporting and paperwork requirements (based on experience with the use of health risk assessments in other states).
  • 3,800 to 4,500 of those remaining could lose coverage due to premiums and fees.

Of those most likely to lose their health coverage:

  • More than a third live in rural areas of Montana. Because there may be fewer job opportunities in rural areas, rural Montanans may experience greater losses.
  • A quarter are in school.
  • A third are parents of minor children.
  • More than a quarter have seasonal employment and work six or more months of the year for wages, but not enough to meet the requirements all year.
  • One-sixth lack internet access, reducing their ability to report their work hours or exemptions.

The report emphasizes that there are uncertainties in these projections: it is not known whether the Centers for Medicare and Medicaid (CMS) would approve certain provisions in HB 658, and how the state would implement them if they are approved. Ambiguities in the bill could also lead to legal and regulatory challenges: the report also notes that according to specific clauses in HB 658, if any of the new work and reporting requirements are not approved by CMS or are voided by litigation, Montana’s entire Medicaid expansion would be terminated.