Contemporary American Indian health concerns have been the topic of a four-part newspaper series by Billings Gazette journalist Jayme Fraser. The articles shed light on the decades-long issue of health disparities that are largely grounded in the inability of the Indian Health Service to meet the health care needs of American Indians. They also review various efforts to improve Indian health currently being undertaken by tribes, individual tribal health/IHS facility administrators, and public and private entities, particularly through nationwide healthcare reforms made available through the Affordable Care Act.
One of those measures encouraged states to expand the income eligibility requirements for Medicaid, which the Montana legislature did in 2015. After that, people earning less than 138 percent of the federal poverty level could enroll in Medicaid. This extended critical health care coverage to an estimated 19,547 American Indians in Montana.
Between November 2, 2015, when enrollment began, and September 1, 2016, the number of newly eligible American Indians who enrolled in Medicaid stands at 6,737, or 30 percent of the total number eligible. American Indian enrollment steadily increases each month, though the rate at which they are enrolling is beginning to slow slightly, demonstrating the need for a more concerted outreach and enrollment effort.
Our latest report details some of the ways outreach and enrollment workers can maximize their success in Indian Country. It is paramount that those engaged in coverage enrollment efforts understand the intricacies of how American Indians access health care. For example, knowing that American Indians have historically tended not to have health insurance, relying instead on the Indian Health Service, helps explain why American Indians may be less inclined to explore other coverage options.
Likewise, having an understanding of the historical and contemporary basis of IHS and being able to articulate the precise benefits of having Medicaid coverage are also necessary. It is also important to know the barriers the eligible demographic faces in accessing information and completing the enrollment process.
Besides supporting current outreach and enrollment efforts, the single most important thing the state can do to help the remaining eligible American Indians access the critical health care they need is to maintain the current eligibility requirements included in the HELP Act.
This week, the U.S. Census Bureau is releasing new data on health insurance coverage, economic, and poverty information both at the national and state-level. Today we’ll take a look at what new insurance coverage data means for families in Montana.
Based on the new American Community Survey data, we know that health care reform has increased the number of insured by offering people access to health care coverage through the health insurance marketplace. Through the marketplace, people can easily compare prices and benefits of health care plans. For individuals that make too much to get care through Medicaid, but don’t make enough to afford private insurance through the market place, federal subsidies help them pay their premiums and reduce their out-of-pocket health costs.
Health care reform has also strengthened Medicaid, which is good for families, communities, and states. Medicaid has been improving people’s lives by providing affordable health care that has boosted state economies for the last 50 years. In 2015 Montana became the 31st state to expand Medicaid through the Health and Economic Livelihood Partnership (HELP) Act, expanding coverage to individuals making less than 138 percent of the federal poverty level ($27,700 for a family of three).
Many states that have expanded Medicaid have seen higher enrollment levels than originally anticipated, and enrollment figures in Montana suggest the same. It was estimated that 70,000 additional Montanans would receive health insurance coverage through expanded Medicaid. In July, just six months after expansion, over 47,000 individuals had already enrolled in the HELP act. Overall, expanding Medicaid has helped reduce the number of Montanans without health insurance. Over the past several years, the number of uninsured in Montana has fell by about five percent, from 165,000 uninsured in 2013 to 119,000 in 2015.
Medicaid is a cornerstone of health care for people who struggle just to make ends meet. Thanks to Montana’s decision to expand Medicaid to help more people who can’t afford private insurance, more people are getting the care they need to go to work, take care of their kids, and be healthy, productive members of their community.
Today’s blog is the last in a series of four blogs on child care in Montana.
Last week we highlighted the need for affordable and quality child care for low-income families in Montana through several blogs and a more comprehensive report. But, no conversation about child care can stand alone. We must acknowledge the need to invest in our early childhood development system as a whole in order to create opportunities for better education and child care for all Montana families.
Several areas we should consider increasing investment include:
Strengthening the child care profession – Child care workers play a critical role by caring for and teaching our children new skills everyday. However, child care employees are some of the lowest paid workers in Montana. Currently, over 2,500 individuals in Montana are employed as child care workers, earning an average of $20,500 a year. These individuals are earning such low wages that they can’t even afford child care for their own children. Additionally, these workers often go without employer-provided benefits like health insurance and sick days and have few options to build their skills and grow in the child care profession.
Paying child care workers fair wages and benefits and providing them access to professional development and training opportunities will enable them to thrive at work, prioritize care for our children, and be able to provide for their families. Doing what’s right for child care workers can also help child care providers attract and retain the best employees possible – which is good for all kids.
Investing in pre-kindergarten – Statewide pre-kindergarten programs could help offset the child care costs that families struggle to afford, not to mention building children’s skills so they can enter school prepared and able to achieve along with their peers. Further, investing in pre-k can strengthen Montana’s economy by supporting working families and creating good-paying jobs in the early education industry.
Supporting families with high child care costs through tax assistance programs. The federal child and dependent care tax credit (CDCTC) allows parents to report up to $3,000 per child in child care costs (for a maximum of two children) and receive a tax credit worth up to 35 percent of qualifying expenses. A single mom with two children in care, for example, could receive up to $2,100 from the CDCTC to help offset her federal income tax.
Currently, 21 states have enacted state CDCTCs based on the federal credit, and more than half of these states have created refundable state credits that enable low-income families to get the most out of the state CDCTC. Montana could enact a state refundable CDCTC set at a fixed percentage of the federal credit and structure the credit to encourage families to use high-quality care providers by offering larger credits to families who use licensed child care providers or providers who participate in Montana’s STARS to Quality program. The state credit would help offset state income taxes, support low-and middle-income families struggling to afford child care, and promote high-quality care, which helps children learn, grow, and succeed in school.
It’s time for Montana to provide resources to help ensure that all parents can access affordable child care and education opportunities for their children. High-quality child care and educational programs, including pre-kindergarten, are key to developing children’s cognitive, social, and emotional skills and preparing them for school. Additionally, investing in areas that support the professionalization of early childhood educators and child care workers would help child care providers better attract and retain skilled employees.
Montana’s child care assistance program offers low-income families access to affordable and quality child are, but some changes are needed.
Today’s blog is the third in a series of four blogs on child care in Montana.
Yesterday, we released a comprehensive report on child care. In our report, we examine the high costs of child care in Montana and how some low-income families can receive assistance to help cover these costs through Montana’s Best Beginnings Child Care Scholarship program. This program reimburses child care providers who care for families with incomes below 150 percent of the federal poverty line ($30,240 for a family of three) and who meet certain activity requirements.
In 2014, an average of 3,000 Montana families received Best Beginnings Scholarships each month, providing care to 4,600 children. Unfortunately, not all families can receive assistance. Over 34,000 low-income children are potentially eligible for Best Beginnings Scholarships, but coverage remains low across Montana. Only one out of seven eligible low-income children receive a Best Beginnings Scholarship (see map).
The highest proportion of children receiving assistance are in Yellowstone County, mostly because of the number of child care options in and around Billings. For example, 22 percent of eligible low-income children received Best Beginnings Scholarships in Area 7 (Yellowstone County), compared to only eight percent of eligible children in Area 1, which encompasses Lincoln, Flathead, and Glacier counties.
There are several reasons why families are unable to access affordable and quality child care through the Best Beginnings Scholarship program, including the following:
- Some families earn too much to qualify for Best Beginnings, but too little to afford child care on their own. Federal requirements allow states to set maximum income eligibility limits for their child care assistance programs. Montana’s Best Beginnings Scholarship program sets its eligibility limit lower than 33 states – at 150 percent of the federal poverty line ($30,240 for a family of three). As a result, 7,500 families fall into this gap, earning too much to qualify for child care assistance, but too little to afford child care on their own. Montana could increase its income eligibility limit, which would provide an additional 30,000 children access to Best Beginnings Scholarships.
- Best Beginnings Scholarship application processes and activity requirements limit access. Montana families can apply for Best Beginnings Scholarships online or at a local Child Care Resource and Referral (CCR&R) agencies. While CCR&R staff help individuals apply for assistance, workers must rely on their employers to verify employment and submit work schedules. This can be a challenge to get employers to comply and if they don’t, parents are disqualified through no fault of their own. Additionally, single parents must work through an additional process to prove that they either receive regular child support payments or provide evidence for why they do not. This process adds another complexity to the application process and can be very challenging for families. The state should consider changes to the application process that take into account the fact that parents are asked to provide documents that are often not in their control.
Additionally, work requirements can keep parents from receiving consistent support. When an employer cuts back on hours, it can cause parents to become ineligible even if they did nothing wrong. Further, the Best Beginnings program does not recognize individuals who are actively looking for work as an acceptable “activity requirement.” Parents looking for work need access to child care so that they can concentrate on preparing for and attending interviews that land them a stable job. The Best Beginnings Scholarship program should consider changing its activity requirements in ways that are flexible and take into consideration the fact that low-wage workers’ schedules are often not in their control. Also, parents looking for work should be able to apply for child care assistance.
- Stagnant funding makes it difficult for the state to adequately reimburse child care providers, which shifts additional costs onto low-income families. Over the past several years, federal funding for state child care assistance programs has stagnated and state investments cannot fully support programs. As a result, the Best Beginnings Scholarship program cannot reimburse child care providers at an adequate rate. When this happens, child care providers either shift additional costs onto families they serve, including Best Beginnings families, or close their doors to Best Beginnings families altogether. Alternatively, when Best Beginnings families stand to face additional costs, they may choose to look for cheaper and lower-quality care. Significant investments are needed to ensure that Montana’s child care assistance program reimburses child care providers fairly, so they are not forced to shift costs onto low-income families.
In today’s economy, more and more families struggle to get by on low wages and to provide resources that enable their children to succeed. Access to quality and affordable child care is one solution that enables parents to maintain stable employment and provides children with the skills they need to succeed in school and beyond.
While current child care costs are often out of reach for many low-and moderate-income families in Montana, some families can receive assistance through the state’s Best Beginnings Child Care Scholarship program. Unfortunately, because of application and eligibility requirements and inadequate federal and state funding, not all families who need child care assistance receive it. Program changes, like increasing eligibility limits to federally recommended levels, and significant state investments to increase reimbursement rates for child care providers would help ensure that more low-income families are able to receive assistance to pay for child care. It would also ensure that low-income families are not subject to additional costs beyond their means and enable them to access high-quality care options in their communities.
Today’s blog is the second in a series of four blogs on child care in Montana.
Access to affordable child care is key to helping low-income families remain employed, supporting families, and building financial security.
All states operate child care assistance programs through the support of the federal Child Care Development Fund (CCDF). Here in Montana, our child care assistance program is called the Best Beginnings Child Care Scholarship Program. The Best Beginnings Scholarship program reimburses child care providers who care for some low-income children. Studies have shown that such programs help low-income parents maintain employment in the following ways:
- Reducing child-care disruptions that pull parents out of work. Low-income parents often do not have access to stable child care, which forces them to scramble to find care for their children before work. Many low-wage workers also do not have access to paid days off, like sick days or family leave, and must rearrange their work schedules to care for their own children when they are sick, causing them to lose out on a day’s worth of earnings or lose their job altogether. Child care assistance programs offer parents access to reliable care options, enabling them to maintain stable employment. A study in Illinois found that families who receive child care assistance were 25 percent less likely to experience problems like missing work, starting late, or quitting work because of child-care issues.
Alternatively, employers suffer when parents have child care challenges. Estimates suggest that U.S. businesses lose up to $4.4 billion each year when employees miss work for child care needs.
- Increasing work hours and earnings. When parents have reliable child care, they are able to show up to work on time and stay for their entire shift, which allows them to work more and remain employed for longer periods of time. A study by the Economic Policy Institute found that mothers with young children who receive child care assistance are 40 percent more likely to be employed two years down the road.
Further, individuals who work more, earn more. Every dollar counts for low-income families, especially for single parents working hard to support families on their own. One study in South Carolina compared earnings over time between single mothers who received child care assistance and single mothers who did not receive assistance. Researchers found that mothers who received assistance saw annual earnings grow by $7,500 over six years, while mothers who didn’t receive assistance saw annual earnings grow only $3,000 over the same period.
- Supporting individuals looking for work. In Montana, over 9,700 low-income children live in families where both (or single) parents are out of work. Child care assistance enables parents searching for work to focus on preparing for and attending job interviews, which can increase the likelihood of finding a job faster and getting back on the path toward financially stability.
Tomorrow we’ll release a comprehensive report on child care in Montana, including affordability, how Montana’s Best Beginnings Scholarship program helps low-income parents pay for child care, and options to improve access to affordable and high-quality care in our state. Friday, we’ll follow up with the third blog in our series, examining Montana’s Best Beginnings Scholarship program in more depth.
It’s back-to-school! The beginning of the school year can take a lot of pressure off of parents who have had to juggle work, summer camps, and child care demands throughout the summer. When kids are back in school, working parents can rest assured that their kids are in a safe and learning environment. But what about parents whose children are not old enough to be enrolled in school yet? This week we’re exploring child care in Montana. Today’s blog, the first in a series of four, delves into child care affordability.
More and more families struggle to get by on low wages and provide resources that support children. Access to quality and affordable child care is one solution that enables parents to maintain stable employment and gives children the skills they need to succeed.
Unfortunately, child care is out of reach for many working families in Montana. On average, a family will spend $7,900 a year ($660 a month) to place their four-year old in full-time center care. The steep cost of child care, combined with a low state median income ranks Montana the 12th least affordable state for child care for families with a four year old. For families with infants, the cost is even higher, running more than $9,000 a year ($755 a month) per infant.
The U.S. Department of Health and Human Services (HHS) considers child care affordable if it consumes less than 10 percent of a family’s income. In Montana, both low-and middle-income families spend above this threshold on child care. For example, a two-parent family with median household earnings ($74,300) and two children in care devotes 21 percent of their total income on child care alone. For this family, child-care expenses exceed even big-budget items like housing and college tuition [Chart 1].
Paying for child care is an even greater challenge for low-income families in Montana. Over 34,000 low-income children are living in households where both parents – or a single parent – must work to pay the bills and put food on the table. These children need safe and stimulating care environments while their parents are at work, but parents who earn low-wages often cannot afford high-quality care. For a single mother working full-time and earning minimum wage ($16,744 a year), the cost of full-time child care for a four-year old makes up nearly half of her entire income (47 percent), taking already strained resources away from basic necessities like rent, food, health care, and transportation.
Some low-income families in Montana qualify for assistance to help cover the costs of child care. Stay tuned tomorrow to learn more about how child care assistance helps parents maintain stable employment, earn more, and enter the workforce. Later in the week, we will learn about some possible solutions to making quality child care affordable for more families.
Number of federally recognized tribes in Montana : 12
Number of state recognized tribes : 1
Number of Indian reservations : 7
Year the Sioux, Gros Ventre, Assiniboine, Blackfeet, Crow, and Cheyenne territories were officially recognized by a single treaty with the U.S. government : 1851
Year the first two reservations were formally established : 1855
Year Montana became a state : 1889
Number of treaties signed by the Cheyenne : 8
Number of treaties signed by tribes now located in Montana that were never ratified by Congress : 6
Year the last reservation in Montana was created : 1916
Number of reservations in Montana created by treaty : 3
Number created by executive order : 3
Number created by Congressional statute : 1
Number of tribal nations in Montana that reorganized their governing structure under the terms of the 1934 Indian Reorganization Act : 5
Number of tribes that have received Self-Governance status : 2
Number currently operating under a 501(c)(3) status : 1
Percentage of the Montana population that was American Indian prior to 1805 : 100
Percentage in 2015 : 6.6
Percentage of Rocky Boy’s Reservation residents who were non-Indian in 2000 : 3.7
Percentage on Flathead : 73.3
Percentage of American Indians who resided in urban areas in Montana in 2000 : 41.6
Percentage of American Indians working off-reservation who pay state income taxes : 100
Percentage of all working American Indians in Montana who pay federal income taxes : 100
American Indian median household income in 2014 : $30,284
Average number of dollars brought into Montana by tribes annually between 2003 and 2009 : $947,727,265
Number of dollars contributed to the Montana economy by tribal colleges in 2009 : $76,200,000
Number of 2-year degree programs offered at Fort Peck Community College : 18
Number of 4-year degree programs offered at Salish Kootenai College : 14
Percentage of full-time students enrolled at Salish Kootenai College in 2014 who were non-Indian : 23.7
Percentage of non-Indian students enrolled at Blackfeet Community College in 2015 : 4
Percentage of inmates serving time in the state prison in 2014 who were American Indian : 27.7
Times greater that American Indians are represented in the prison population than in the state population : 4.2
Number of American Indians serving in the state legislature in 2015 : 8
Percentage that are female : 63
Average life expectancy of American Indian women in Montana in 2013 : 62
Average life expectancy of American Indian men in Montana : 56
Average life expectancy of a non-Indian man in Montana : 75
Median age of American Indians in Montana : 29
A few weeks ago, the Montana Budget and Policy Center released its new report – The Montana We Could Be. The report details how the income tax cuts passed in 2003, which largely benefited wealthiest households – has resulted in millions in lost revenue. This revenue could have gone to targeted investments into our communities. One area of focus is the ongoing needs in infrastructure – maintaining roads and bridges, water systems, and quality schools. As shown in the chart, the needs far exceed current levels of funding. Last session, the legislature failed to pass a bipartisan infrastructure package, which would have provided $150 million for new infrastructure projects.
As another school year is about to start, several long-time teachers – residing in three Montana communities – highlighted the need for investments in education, including school facilities. Teachers across Montana do an incredible job each day ensuring that our children are given the opportunity to succeed in this state. But too often, educators are faced with teaching our next generations in facilities that fail to provide the 21st Century learning environment that our children need to succeed in today’s world. Even worse – basic maintenance issues continue to stack up – leaking roofs, impaired heating systems, and electrical problems. More than two-thirds of Montana’s schools were constructed before 1970, and a report from 2008 shows overall deferred maintenance needs exceeds $900 million.
We can and should do better. As our report and yesterday’s op-ed highlights, Montana is faced with a tight budget, in part, due to tax cuts put in place over a decade ago. These tax cuts – billed as a way to grow the economy – resulted in deep tax cuts for the wealthiest households, while the vast majority of Montana families saw little or no benefit. Over the past decade, these tax cuts have cost the state nearly $1 billion in lost revenue – revenue that could have been invested in our children and our communities.
Meanwhile, local cities and towns – and local property taxpayers – are left holding the bag to ensure our neighborhoods and schools can thrive. While state K-12 funding has increased over the past two decades, property tax revenue used to pay for education has increased at a much greater rate.
Over the years, Montana families and our communities have stepped up to ensure our children can succeed. We know our entire state moves forward when we have a quality educational system. However, we also must ensure everyone is paying their fair share and carrying their weight. It is time to reform our tax system to ensure the wealthy are paying their fair share, so that we can invest in a brighter future for Montana.