Continuing Medicaid Expansion Enrollment: What can we learn from other states?

Without a doubt, the first three months of enrollment in new affordable health care coverage in Montana has been a true success. The state health agency announced yesterday that, as of March 15, over 38,000 Montanans have gained health insurance through Medicaid expansion. Our blog post earlier this week highlighted the majority of these newly enrolled individuals are living in poverty (many in deep poverty), many of whom have never been able to afford health insurance. The enrollment numbers are exceeding expectations, but it was also not surprising that the state experienced strong enrollment during the months that coincided with open enrollment for health insurance on the federal Marketplace.

It is important to note that the enrollment period for Medicaid is year-round, and the state and other partners must continue to look at ways to improve its outreach. Today, MBPC released its new report looking at some strategies that other states have utilized to expand outreach and enrollment. The report includes specific examples and lessons learned. These lessons come from a number of excellent research reports from the Kaiser Family Foundation, as well as, our direct conversations with individuals engaged in enrollment efforts in Colorado, Indiana, and Washington.

Here are some highlights:

  • Outreach materials are most effective when the information speaks specifically to the personal benefits of having insurance and can be tailored to specific regions or demographics. For example, the state of Washington provided local navigators flexibility in modifying enrollment materials for different regions of the state.
  • Continuous tracking and analysis of enrollment data by region and demographics can help the state better target outreach on an ongoing basis. For example, the Colorado Health Institute conducted a detailed analysis of uninsured levels based on zip code, allowing the state to better target outreach efforts. Colorado targeted rural areas through direct mail cards with details on who qualifies and how to apply.
  • States have also successfully utilized community locations, such as shopping malls, libraries, and schools, to educate the public about affordable health coverage and enroll individuals in Medicaid. The state of Washington set up kiosks at local malls and tied its marketing campaign to the idea of “shopping” for affordable health insurance.
  • States have found other partners that may not be directly tied to health care system to help get the word out. Colorado enrollment assisters engaged for-profit entities, including pizza delivery companies and supermarkets, to include enrollment information during delivery or checkout. Kentucky has utilized community leaders, including faith leaders, to help spread the word of health insurance opportunities.
  • Outreach efforts to inform American Indians of new coverage opportunities in Medicaid must recognize how having health insurance relates to accessing care through IHS, Tribal health clinics, Urban Indian health centers. Outreach efforts should emphasize that American Indians can continue to access care at IHS, tribal, and urban Indian clinics. Gaining access to Medicaid allows clinics to access reimbursements for services through Medicaid, which frees up IHS funds to increase and improve health services for their communities.

We encourage you to take a look at the report, and we look forward to working with our partners across the state to continue to emphasize the success of Medicaid expansion in Montana.

Medicaid Expansion: Enrollment to Date

In just the first few months of new coverage under Medicaid expansion, we are seeing significant enrollment levels and evidence that thousands of Montanans need (and are now receiving) affordable health insurance. This month, the Montana Department of Public Health and Human Services (DPHHS) released new data on the number of people who have enrolled through the Montana Health and Economic Livelihood Partnership (HELP) Act. Since enrollment began on November 2 (with coverage beginning on January 1), over 36,320 Montanans have signed up, exceeding first-year projections on all levels.

This week, we will release a new report analyzing this enrollment and the populations that the state should consider focusing future outreach efforts. The report will also detail a number of successful strategies that other states have deployed to reach eligible families and get them enrolled.

As a preview of this work, here are some of our thoughts so far on enrollment.

Income levels

It is not surprising that Montana has seen a significant portion of newly enrolled individuals at very low incomes. So far, over 60 percent (or approximately 22,000) of those enrolled are living with family incomes below 50 percent of the federal poverty line. For an individual, this represents an annual income of $5,990, or about $490 per month. These are families that, in the past, have had few or no options for affordable coverage. The state and other partner organizations did incredible work to reach these populations using existing data and let them know they would be eligible for new health care coverage options in 2016.

We know that a significant percentage of the uninsured population below 50 percent has now enrolled; future enrollment efforts may be best targeted to populations with incomes between 50 and 138 percent of FPL. This population will be enrolled in the HELP Plan and subject to premiums and copays, so it is critical that the state’s materials are clear on what these premium levels are and the importance of gaining health insurance.

American Indians

While we have seen over 4,300 American Indians enroll, this number is low compared to the estimated percentage of the entire eligible population that is American Indian. According to Census data, American Indians represent nearly 20 percent of the total eligible uninsured population. And yet, only 12 percent of newly enrollees are American Indian.

Outreach efforts focused on eligible American Indians must take into account the unique health care dynamics, including how insurance relates to accessing services through Indian Health Service (IHS), tribal health clinics, and urban Indian health clinics. The state should work closely with tribal leaders and tribal advocates to ensure enrollment is supporting this existing tribal healthcare infrastructure. These types of partnerships are happening across the state, but even more can be done to support health coverage enrollment in Indian country.

Regional differences

We are seeing regional health departments and health centers actively engaged in enrollment efforts across the state, but enrollment numbers show opportunities to expand efforts in certain areas. Over 56 percent of enrollment has occurred in the top five counties in Montana (Cascade, Flathead, Gallatin, Lewis & Clark, Missoula, and Yellowstone counties). And while all five counties are reaching significant numbers of newly eligible, Gallatin County is lagging behind the other counties when comparing enrollment as a percent of eligible uninsured population.

MBPC commends the state, those engaged in Cover Montana, and others involved in enrollment efforts. The need for the HELP Act is clear – with over 36,000 Montanans accessing coverage in just the first couple months.

But thousands more Montanans are eligible. Stay tuned for the release of our report later this week, which will detail our research on strategies that other states have undertaken to reach eligible individuals and get them the health coverage they need.

VITA Awareness Day: VITA volunteers help Montanans build financial security.

Today is VITA Awareness Day! To help us celebrate, our partner with Montana Credit Unions for Community Development highlights the impact of VITA sites in Montana.

For many folks, tax season can be a stressful time. For over a decade, Volunteer Income Tax Assistance (VITA) sites have been trusted spaces in Montana communities where working families can go to get help in filling out their income taxes. The VITA program provides low-and moderate-income families access to free and easy tax-preparation services, and nationally, has put billions of dollars back into the pockets of hard working Americans.

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In Montana, IRS-certified volunteers in over 60 VITA sites and numerous Tax Counseling for the Elderly (TCE) sites offer their community members a free alternative to more costly, and sometimes predatory, tax preparation services. In 2015, volunteers serving in VITA/TCE sites helped return over $16 million dollars in federal income taxes to more than 16,000 working Montanans. Because these services do not cost eligible filers a dime and have far lower error rates than self-and paid-tax preparers, tax filers are able to claim more of what they earn, which helps them better make ends meet, build financial stability, and save for the future.

VITA volunteers also help raise awareness about the federal earned income tax credit (EITC) and ensure that working Montanans claim the credit at the correct amount. Research shows that the EITC lifts millions of working families out of poverty every year, encourages single parents to work more, and improves children’s school performance and earnings later in life. But while the EITC is regarded as one of the best anti-poverty programs in history, 20 percent of eligible tax filers do not claim the credit.

Last year, VITA/TCE volunteers in Montana helped provide over $5 million to 4,000 low-income working families through the EITC. These families were able to use their refunds to get caught up on bills, pay for basic necessities, like food and utilities, and cover expenses like car repairs, which helps secure a reliable form of transportation to get to and from work.

Every year, the VITA program helps low-and moderate-income working families make the most of their refunds, which improves their financial security and supports local economies. If you haven’t filed your federal income taxes yet, you may be eligible to receive free preparation services at a local VITA site. To learn more, check out Montana Free File.

Carin McClain is the Tax Program Manager with Montana Credit Unions for Community Development (MCUCD). In her role, she recruits and manages volunteers, directs tax law trainings, helps coordinate the statewide MVP Coalition, and works to build capacity and sustainability for her program.

President requests funding for 2Gen initiatives in 2017 Budget

Yesterday, we covered 2Gen as our Wonky Word Wednesday. Today, let’s see how President Obama has considered 2Gen initiatives in his 2017 budget.

Reforming Temporary Assistance for Needy Families (TANF) – TANF is a federal program that provides a safety net for families living in severe poverty. For the most part, TANF provides families with cash assistance so they can meet their basic needs, like paying for rent or buying groceries. However, while TANF has many flaws, it is an example of how to look at services from a 2Gen angle. For example, TANF includes both work supports for parents and subsidized child care for children. But policymakers can do more to improve TANF, and we’re pleased to see the President’s budget includes some of those changes.

Based on the proposed budget, the federal TANF program stands to benefit in two major ways. First, because TANF funding is not adjusted yearly to account for inflation, funding has lost up to 30% of its value since the mid 1990s. To make up for some of this lost value, President Obama’s budget proposes to invest an additional $8 billion dollars into the program over the next five years

Second, the budget proposes to shift up to $100 million in TANF funds to better support core programs, including work supports and subsidized child care for parents and families, and mental health and educational activities for children.

Reducing Child Poverty in Rural Areas – To combat poverty in rural communities throughout America, the budget also proposes an investment in 2Gen initiatives that will align early childhood education programs for children and workforce development programs for their parents, in an effort to put families on track to economic security. This includes $16 million to support early childhood education and parental involvement programs in schools funded by the Bureau of Indian Education (BIE) and serving American Indian families.

These are just a few of the investments that President Obama’s 2017 budget proposes and it is the first time a president’s budget has specifically requested funding for 2Gen initiatives. We hope that Congress seriously considers these requests and recognize that these programs strengthen families’ educational, economic, social, and health outcomes from one generation to the next.

Wonky Word Wednesdays: Two-Generation (2Gen)

For today’s Wonky Word Wednesday, we’ll examine an approach aimed to support families experiencing poverty, called a two-generation method. And tomorrow, we’ll then talk about some of these approaches and how policymakers can support them.

Too often, policies aimed to reduce poverty focus on either children or their parents, not the whole family. Solutions miss the mark when they focus just on children, without addressing issues like work support for their parents.

A two-generation (often referred to as 2Gen) approach creates policy or programmatic solutions that move the entire family toward economic security. The Aspen Institute’s project on 2Gen has identified four core components that individuals should focus on in order to create impacts that will pass from one generation to the next:2gen

Education – When parents have access to quality and affordable education and workforce development programs for themselves, they earn more – and in turn – can better provide for their children. Likewise, children need access to quality early childhood education programs, like pre-kindergarten. When they do, they perform better in school, are less likely to commit crimes as adults, and have higher earnings later in life. These two components can often be provided simultaneously. For example, Flathead Valley Community College provides a state-of-the-art pre-kindergarten program on campus for students, faculty and the community.

Social Capital – Social capital refers to the networks of relationships that individuals have in their communities, which provide them with information, resources, and support. Families rely on these trusted networks among their friends, family members, neighbors, work colleagues, and local organizations in order to get what they need to thrive. For example, parents with access to affordable and quality child care providers are able to remain working and have the piece of mind that their children are in a safe environment.

Economic Supports – Access to financial education and asset building opportunities, like savings accounts, increase parents’ earnings and put them on a path toward a stable financial future. For example, efforts to provide parents with the ability to save for a child’s college education provides the direct benefit of making post-secondary education more feasible for the child, but it also helps build the parents’ skills and understanding in the importance of saving.

Additionally, research shows that children who move out of poverty early in life benefit as adults. For example, children of parents who receive the federal earned income tax credit are more likely to attend college and have higher earnings later in life.

Health and Well-Being – families need access to programs that enable them to remain healthy and ensure their well-being, including mental health services and addressing negative childhood experiences. While Montana has provided access to health care for hundreds of thousands of children in Montana, it is also important to provide affordable access to health care for their parents as well. With Medicaid expansion in Montana, low-income parents can afford health care and take preventative measures for themselves and their children. Healthy parents remain working and providing for their families and healthy children remain in school and learning.

Applying these core principals to programs, policies, and research – at both the state and federal level – will help families build economic security that extends from one generation to the next. Stay tuned to learn how President Obama used 2Gen in his 2017 budget.


On FMLA’s 23rd anniversary, poll shows that it’s time for paid leave

Today marks the 23rd anniversary of the enactment of the Family Medical and Leave Act, our nation’s unpaid leave law. Much has changed since its creation and today, working Americans need PAID leave in order to balance work and home demands.

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Congress passed the FMLA in 1993. The federal law provides employees who work at least 1,250 hours in the past 12 months and who are employed by businesses with 50 or more workers up to 12 weeks of unpaid leave each year to care for a new child, a sick family member, or to recover from their own serious illness. Workers taking FMLA are also guaranteed job protection so employers cannot fire them during this leave.

While the FMLA provides working families greater protection, many working Americans – and Montanans – do not qualify for the FMLA. And even among those who do qualify, many employees cannot afford to take unpaid time off work.

Debra Ness, President of the National Partnership for Women and Families, which led the fight to enact FMLA in 1993, states that “America’s workplace policies have failed to keep pace with the realities of people’s lives” and that workers need something better.

A new poll from the National Partnership for Women and Families shows support for paid leave across party lines, racial and ethnic groups, and men and women. Results show that:

  • 4 out of 5 likely 2016 voters think it is important for elected officials to update the FMLA in order to guarantee paid family and medical leave.
  • 76 percent of voters would support a national paid family and medical leave insurance program that would offer workers up to 12 weeks of paid leave.
  • Voters are far more likely to feel their elected official understands their family needs if the official supports a paid family and medical leave law.

Currently, only 13 percent of working Americans have access to paid family leave through their employers, and fewer than 40 percent have access to medical leave through their employers’ temporary disability insurance programs.

While the FMLA was a step in the right direction, it is clear that voters want the peace of mind that they can take time off to attend to their own health needs or care for a family member and remain financially secure. Lawmakers who support paid leave legislation will prove to their constituents that they understand today’s families, share their values, and are working to create better opportunities that strengthen families, businesses, and the economy overall.

GUEST BLOG: Balancing Work and Family without Paid Leave

Today, the Montana Budget and Policy Center will hear from one Montanan and her story of trying to balance family and work.


Like many people of my generation, I have what is called a “patchwork” income. I teach online writing classes part-time for the University of Montana, Central Texas College and occasionally other schools. I also do freelance writing, editing and instructional design to make ends meet. I am a hard worker–in fact I really enjoy working and keeping busy. None of the schools I work for have ever offered me full-time work, or even have full-time positions available. I organized my life around this reality, paying for private health insurance and working my own retirement accounts into shape. All of that was fine with me until I became a mother.

Because of my “patchwork” income, I don’t get much time off. None of my positions offer me sick leave, maternity leave, or any type of paid family leave as a part-time or contract employee. So, hours after the births of both of my daughters I did something I should not have had to do–I opened my laptop and got to work. During the first few sleepless months, I chugged some espresso each morning and graded papers. And the next day, I graded more papers. Regardless of my hard work and loyalty to these institutions and their students, I did not get maternity leave.

Natalie pictureHaving to live this way is not good for me–but I can handle that. I can set my own needs aside. But it is also not good for my daughters, whose mother has to balance a set of unfair demands. It is hard to be calm and refreshed while juggling so much. It is also not good for my students, who pay tuition and are pretty sure a real professor is on the other end of their WiFi signal, not just a disposable contract employee with no long-term ties to the institution.

I am lucky, though. I have a supportive husband and wonderful friends that have swooped in to save me along the way. I also had private insurance and a savings account. Many people in my situation do not have those things.

One would think women would have the right to some rest after the physical toll that having children takes on your body and the sleepless nights an infant brings after that. Children should have the right to a rested, devoted mother, at least for a little while.

Being a working mom is hard, but it would have been a bit easier if I had time to heal and care for my newborn children. As I look forward, it’s scary to think that, by not having access to paid leave, I risk losing my income and even possibly my job, if anything serious should happen to my daughters, my husband, or myself. Paid leave would help me be a better mom, wife, teacher, employee, and member of my community. I’m excited about what is happening around the country with paid family and sick leave–I hope Montana pays attention.

Natalie Peeterse

Wonky Word Wednesdays: Volunteer Income Tax Assistance (VITA)

It’s that time again, another Wonky Word Wednesday. With many Montanans receiving their W2s and free tax prep sites opening their doors this week across the state, tax season is officially off and running.

Let’s delve into a service that makes it easier for you to get more of what you earn back and invest in your community. Today’s wonky word is VITA (Volunteer Income Tax Assistance).

VITA is an IRS program that was created in 1971 to help low-and moderate-income taxpayers receive free tax filing assistance. Visiting a local VITA site enables individuals to file taxes without errors, receive their refunds sooner, and claim credits that can be overlooked, like the federal earned income tax credit (EITC), or deductions for students paying for college.

Every year, fellow Montanans around the state volunteer their time – usually from January through April – first becoming IRS-certified volunteers and then helping individuals in their community file electronic income tax returns free of charge.

Individuals with yearly incomes of $54,000 or less and with fairly straightforward returns qualify for free services through VITA sites and can pick from many site locations. This year, organizations focused on improving Montanans’ financial security, like Montana Credit Unions for Community Development and Rural Dynamics, Inc., are operating over 60 VITA sites located from Missoula to Glendive and in between.

Additionally, 25 free tax assistance sites through AARP are also located throughout Montana, geared toward providing individualized tax preparation for low-and middle-income seniors. However, non-AARP members can also receive free tax filing support through these Tax-Aide sites too.

Learn more here to see if a free tax site is located near you and what materials you may need.


National Girls and Women in Sports Day

Did you know that tomorrow is National Girls and Women in Sports Day?

To celebrate, we thought we would do some digging into pay equity in sports.

Sports that deserve recognition:

Marathons – The World Marathon Majors is a series that includes six of the largest and most well known marathons in the world, including New York, Boston, London, Tokyo, Berlin, and Chicago. Winning men and women receive equal prize money when they participate.

Tennis – In 2007, Venus Williams shamed the All England Club (which hosts Wimbledon) into paying both male and female champions the same prize money. There is a whole documentary about how she did it called “Venus Vs.” Now all four grand slam tournaments pay the same amount to male and female players.

Surfing – In 2012, after undergoing new ownership, the World Surf League made a policy to pay men and women equal prize money.

Sports that should be embarrassed:

Golf – The total prize money for the PGA tour is more than five times that of the Ladies PGA, a difference of more than $275 million a year.

Basketball – In the WNBA, female basketball players can earn between $38,913 and to $109,500 annually. However, in the NBA, male basketball players’ salaries range from a low of $525,093 to a maximum of $16 million per year. To be clear, the maximum salary for a professional female basketball player is only 20% of the minimum salary for a male basketball player.

Soccer – After winning the 2015 Women’s World Cup, the US team won $2 million in prize money. Compare this to the staggering $35 million awarded to Germany’s men’s team, which won the year before. The US men’s team – who placed 11th – collected $9 million.

Clearly, equal pay isn’t just an issue for everyday workers. As a reminder, women in Montana make 67.5 cents to every dollar men make. Montana women earn less than men in every occupational category and industry, despite the fact that more women have high school diplomas and bachelor’s degrees than men.

We know that Superbowl is coming up, but in the next week take some time to appreciate women in sports. There are plenty of talented athletes in high schools and colleges to cheer on. And be sure to take your sons, daughters, nieces, and nephews with you.

Note: Much of the information in this post was found at the Women’s Sports Foundation.

Open Enrollment Wraps Up, but Medicaid Enrollment Will Continue

The open enrollment period for accessing private insurance on the Marketplace exchange ended last night at midnight. However, those who missed the deadline may qualify for a Special Enrollment Period (SEP) — generally triggered by a change in circumstances, such as:

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  • moving to a new state, or to a place within the same state where different Qualified Health Plans (QHPs) are available;
  • losing other health coverage;
  • gaining or becoming a dependent (e.g., through marriage, birth, adoption, placement for adoption or in foster care, a child support order or other court order);
  • meeting other “exceptional circumstances”.

Montanans should visit the Marketplace website or to see if they qualify for a SEP.

It’s also important to note that there is no deadline for enrolling in Medicaid. To find information on eligible income levels and how to enroll, go to or