New Report: Up to 36,000 Low-Income People in Montana Could Lose Health Coverage If State Imposes Medicaid Work Requirements

WASHINGTON, DC (Feb. 13, 2019) — An estimated 26,000 to 36,000 low-income people in Montana would lose much-needed health coverage under a proposed bill to impose work requirements on Medicaid recipients, according to an analysis published today by researchers at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University. In addition, 5,000 to 7,000 more could lose health coverage due to higher premiums.

Kentucky, Arkansas and other states are also trying to force Medicaid recipients to work – or lose their health coverage. A federal judge struck down Kentucky’s plan in June 2018 but the case is back in court. Public health scholars recently filed a friend of the court brief asking the judge to block Kentucky’s work requirements, arguing that they are illegal and run counter to the very purpose of the Medicaid program.

The Montana bill, called the Medicaid Reform and Integrity Act or MeRIA, would require 19- to 59-year-old Medicaid enrollees in the state to work 80 hours per month – or lose their health coverage after three months. The analysis is based on a Feb. 5 draft of MeRIA. The draft legislation would also increase premiums for those enrolled more than two years and terminate 12-month continuous eligibility.

“If enacted, we estimate this bill would cause a total of between 31,000 and 43,000 low-income Montanans to lose their Medicaid coverage,” said Leighton Ku, PhD, MPH, lead author of the report and a professor of health policy and management at Milken Institute SPH. “Many people likely to lose coverage are already working when they can or they live in rural areas and are unable to find a job.” 

Montana has already pioneered a successful voluntary work promotion program, called HELP-Link, which helps Medicaid enrollees find work, but does not threaten to take away their health insurance if they cannot find steady work.  The proposed policies might cause many Montanans to lose insurance, but not actually help more people find work, Ku said.

Of those most likely to lose their health coverage, the report found:

  • One out of four are parents of young children.
  • One out of four have family members with a disability.
  • One out of four are in school.
  • More than a third have seasonal employment but not enough hours to meet Montana’s work requirements.
  • More than a third live in rural areas of Montana – far from the economic hubs of the state where jobs are more plentiful.
  • One-ninth are Native American.  More than 3,000 could lose insurance coverage.

“Poor people understand that working more increases their incomes but may not be able to find steady work because of limited job opportunities,” said Ku, who is also the director of the Center for Health Policy Research at Milken Institute SPH. The report said most job growth in Montana has occurred in urban areas such as Yellowstone, Missoula, Gallatin and Flathead Counties – but has stalled or declined in rural regions.

Montanans who lose insurance coverage under this bill will have reduced access to health care, which could worsen chronic health conditions and threaten their financial well-being, Ku said.

In addition, the report says hospitals, community health centers and similar medical facilities – particularly those in rural parts of the state – will lose Medicaid revenues but will also have to care for a surge of uninsured patients. That one-two punch will destabilize many medical facilities financially and increase the risk of cutbacks or even closures.

Even people who meet Medicaid work requirements or who qualify for exemptions would still be at risk of losing coverage because of the burdensome reporting requirements under the bill. For example, many people lack internet service or cell phone data plans and could have serious problems trying to report their hours or exemptions, the report said.

The proposed bill would also raise the monthly premium that recipients must pay in order to gain coverage. The report says many low-income people in the state already have trouble paying their premiums and the increase would cause as many as 9 percent to lose coverage.

Ending the state’s 12-month provision for continuous Medicaid coverage would disrupt continuity of health care, according to the report. Such disruptions would be particularly dangerous for people with chronic health conditions. For example, without continuous health care coverage, diabetics might not be able to afford insulin and skimp on doses – thus putting themselves at high risk of serious complications or even death.

 “Potential Effects of Community Engagement Policies in Montana’s Medicaid Program,” was authored by Ku and Erin Brantley, MPH, a senior research associate at the Center for Health Policy Research at Milken Institute SPH.