Congress Needs to Give Families the Gift of Security & Fully Fund CHIP

‘Tis the season for the sniffles.

As the mom of three kids – two preschoolers and a baby – we see our fair share of colds, stomach bugs, and other wintertime illnesses. It’s simply impossible to keep everyone healthy year round.

But even when I’m up to my elbows in tissues and chicken noodle soup, I am thankful that I can take my kids to the doctors when necessary. Maybe the toddler needs medicine to stop wheezing during a bad case of croup, or the baby has to go to the Emergency Room for a high fever. Our health insurance means that no matter how unpleasant childhood illnesses are, we don’t have to worry about the financial stress that can too often accompany them.

But the 23,000 Montanan children who receive insurance through Healthy Montana Kids, also known as the Children’s Health Insurance Program (CHIP), might soon lose that stability. Back in September, Congress allowed funding for CHIP to expire and has yet to reach a compromise. Some states are already starting to run out of money to fund their programs, Alabama will freeze CHIP enrollment in two weeks if Congress does not extend funding, and Montana will run out by the end of January.

So what’s the hold up on renewing funding for this historically bipartisan program? Democrats and Republicans disagree on how to pay for it. The current “continuing resolution” bill in the House funds CHIP by shortening the grace period for people who miss an insurance payment to sign up again from 90 days to 30. This change would result in nearly 700,000 people losing their insurance across the country. Robbing Peter to pay Paul is no way to fund such a vital program.

Last week, all three of my kids came down with colds simultaneously and I crossed my fingers that we would all be healthy before the holidays. No kid wants to be sick while waiting for Santa, lighting the menorah, or ringing in the New Year. And no parent wants to worry about how they will pay their bills if those sniffles turn into something more serious.

Before heading home for the holidays this Friday, Congress needs to give families the gift of security and fully fund CHIP. Montana families can’t keep waiting.

Guest Post: Fix the Funding Cliff Now

The waiting room of Montana’s Community Health Centers are thousands of miles from the U.S. Capitol, but what happens under that dome is hurting the health of thousands of Montanans.

Right now, Montana Community Health Centers are experiencing a federal funding cut of 70 percent that took effect October 1. Centers across the state are making hard choices to trim costs, save jobs, and keep doors open. Our health centers are not alone. The federal Department of Health and Human Services (HHS) has projected that the impact of the funding cliff will result in the closure of 2,800 health center locations, elimination of more than 50,000 jobs, and a loss of access to care for more than 9 million patients. The disruption is already evident. Many health centers in Montana are already making the tough choices about cutting costs amid a massive funding shortfall – implementing hiring freezes, cutting back on programs and deciding whether to close rural sites. In rural areas, where people typically drive miles in any direction to a provider, site closures will pose a significant hardship.

Why should this matter? Because we save lives. In Montana, 17 community health centers in 48 locations are part of a nationwide network that started more than 50 years ago to provide quality primary care in places where doctors and services were scarce or non-existent. We are the family doctor to more than 106,000 Montanans in communities all across the state, almost 1 in 10 Montanans receive their healthcare in one of our health centers. We provide affordable access to primary care and help reduce the incidence of chronic disease in the most economically challenged rural and urban communities all over Montana. Our patients have a more affordable option for preventive care than a hospital emergency room, a fact which allows us to generate millions in health care cost savings in Montana. We are also innovators, working with community partners to respond to public health crises, such as the opioid epidemic and the recent wildfires that raged this summer in Lincoln and Seeley Lake.

There is little doubt that health centers have contributed significantly to cost savings for the American taxpayer. Not only do most Republicans and Democrats support our program, they also want a funding cliff fix. So why can’t Congress get the job done? We are up against a host of factors that include a ticking clock and a busy legislative calendar that is focused on dollars, not doctors or the people who need them.

Congress must act now and turn their attention to fix the community health center funding cliff. Let’s hope they act before it’s too late.

Cindy Stergar

CEO, Montana Primary Care Association

MPCA is the association of Montana’s community health centers, and works to support and increase Montanans’ access to excellent, patient-centered health care. The Mission of the Montana Primary Care Association is to promote integrated primary healthcare to achieve health and well-being for Montana’s most vulnerable populations.

This tax bill is a health care bill too.

We anticipate that the House and Senate will vote on the final GOP tax plan early next week. While this proposal is first and foremost a give-away to the super wealthy and corporations, it’s important to remember that it is also a direct attack on the health care coverage of Montanans.

We briefly explained in an earlier post about why the Senate tax bill would hurt Montanans with health care needs. Today we are going to take a closer look at how this tax bill is a health care bill too:

If the Affordable Care Act’s individual mandate were repealed, 13 million more Americans would go uninsured. While the Congressional Budget Office (CBO) notes that the magnitude of the coverage effects is uncertain, it concludes that there’s no doubt that “the number of uninsured people would be millions higher.”

In Montana, 146,717 people are enrolled in Medicaid as of September 2017, and 86,000 people are enrolled in Montana’s Medicaid expansion as of November 2017.

And, thanks to the Affordable Care Act, Medicaid and the Children’s Health Insurance Program (CHIP), 92 percent of Montana’s children now have health insurance coverage.

With over 232,000 Montanans insured through Medicaid and Medicaid Expansion, cuts to Medicaid would be devastating for our state. Montana is already grappling with an opioid epidemic, as well as major funding cuts to support rural health care needs and Montanans with disabilities. As recent media has reported, Medicaid and Medicaid Expansion has been a critical lifeline for Montanans.

Without the ACA individual mandate, individual market premiums would also increase 10 percent. Fewer healthy people would sign up for individual market coverage with no mandate, which would increase average costs and therefore premiums in the individual market as less healthy and young people enroll and more people with expensive medical needs tilt the cost of health care needs.

The Congressional Budget Office (CBO) estimates that repealing the mandate would permanently raise premiums by 10 percent, and some major insurers have projected larger effects. As Senator Collins has noted, these premium increases would likely erase — or more than erase — the Senate bill’s tax cuts for millions of people who buy coverage in the individual market. Unaffordable premiums should not be a barrier to folks who need coverage.

The individual mandate is also critical to keeping the individual market stable. As the American Academy of Actuaries commented in its recent letter to Senate leaders about repealing the mandate, “increased uncertainty and instability regarding future enrollment, premium rates, and risk pool profiles if coverage incentives are eliminated would increase the risk of insurers incurring losses. Insurers would likely reconsider their future participation in the market. This could lead to severe market disruption and loss of coverage among individual market enrollees”

And last, but not least, if repealing the individual mandate is included in the final federal tax plan, it would also result in the loss of $5.5 million in general fund revenue per year for Montana. Since it is predicted less Montanans would enroll, the state would lose revenue from no longer collecting the health insurance premium tax from enrollees.

Affordable health care coverage for Montanans is a value that we all share. Our Montana congressional delegation should work to advance tax policies that strengthen the state of Montana and invest in our working families. Equally, our congressional delegation should support health care legislation that strengthens the Affordable Care Act—not provisions that work to cut it down.

Montana Families Rely on the Children’s Health Insurance Program: CHIP Facts

The Children’s Health Insurance Program (CHIP) provides vital coverage for thousands of Montana’s children. Federal funding, however, expired at the end of September 2017, jeopardizing financial stability for families and for the state.

CHIP birthsMontana cannot afford to provide coverage to CHIP families without continued federal funding, and Montana families cannot afford to lose their children’s health insurance. Our elected officials in Washington, DC must act immediately to continue this vital program.

To learn more about CHIP in Montana and what is at risk with its expiration, read our CHIP fact sheet – Montana Families Rely on the Children’s Health Insurance Program.

House and Senate GOP Health Bills Endanger Healthy Montana Kids Program

Healthy Montana Kids (HMK) provides vital health care coverage to more than one in three children in Montana. HMK, which includes both children’s Medicaid and the state’s Children’s Health Insurance Program (CHIP), not only improves the health of children, it also has lifelong impacts on recipients’ physical and financial well-being.

The Senate GOP proposal to repeal and replace the Affordable Care Act (ACA), called the Better Care Reconciliation Act (BCRA), would cut Medicaid by nearly $800 billion over ten years. By capping the amount of money states get from the federal government, this bill would shift significant costs to the states, forcing them to cut services and potentially the number of individuals covered. This report provides an overview of HMK and details the risk to HMK if the BCRA passes.

Some of the key facts and figures from the report include:

  • Over 120,000 (more than 1 in 3) children in Montana are covered through HMK.
  • Half of all births in Montana are covered through HMK.
  • Ninety-two percent of all Montana children have insurance, in large part due to HMK.
  • Roughly half of all Medicaid enrollees in Montana are children.
  • Schools in Montana receive $55 million in Medicaid funds – $36 million of which is federal.
  • Medicaid covers 100% of children in foster care, 71% of children living in poverty, and 50% of children with disabilities.
  • Under the original Senate bill, Montana would lose $5.3 billion in federal Medicaid funds, putting at risk Health Montana Kids and access to coverage for thousands of Montanans.

Here is the full report: House and Senate GOP Health Bills Endanger Healthy Montana Kids Program.

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The Next Steps for Medicaid Expansion

The Montana Budget and Policy Center is celebrating this week, as legislators on both sides of the aisle worked together to pass Medicaid expansion in both the House and Senate. After passing third reading in the Senate on Saturday morning, the Montana HELP Act is on its way to the Governor’s desk, where he is expected to sign the bill into law. And while some very hard work is behind us, we’re not quite done yet.

Once the Governor signs the Montana HELP Act, Medicaid programming will not immediately go into effect. Next, the state will have to submit a section 1115 waiver to the federal government to expand coverage and receive increased federal funds. Section 1115 waivers allow states to pursue experimental, pilot, or demonstration projects that promote the objectives of Medicaid, namely to keep low-income families healthy. (It’s called “1115 waiver” for short, because of the section in the Social Security Act where this flexibility is provided.)

Most of the 28 states that have expanded Medicaid coverage did it in the “traditional” form. The state simply raised eligibility levels under its current Medicaid program and accepted the higher federal match to do so. However, six states (Arkansas, Indiana, Iowa, Michigan, New Hampshire, and Pennsylvania) expanded coverage through the 1115 waiver process, which enables the state to craft its own expansion plan while still promoting the goals of the Medicaid program and protecting enrollees. Montana will join these states in expanding coverage using this waiver.

The Montana Department of Health and Human Services (DPHHS) will submit the 1115 waiver for approval by the federal Center for Medicaid and Medicare Services (CMS). CMS has made it clear that it will not approve a waiver that limits the number of eligible people who can be enrolled under the plan. The waiver request must also show that the program will not cost the federal government more than traditional expansion over a multi-year period (otherwise known as budget neutrality).

As DPHHS and stakeholders in the state move forward with this process, which will take a few months, we can learn from other states that have received waiver approval from CMS.

  • Waiver approval requires Medicaid expansion to cover adults up to 138% of the poverty line. No doubt, Montana’s waiver must include this feature (and the HELP Act does); otherwise the state will not qualify for enhanced federal matching funds that are critical for covering newly eligible enrollees and lowering uncompensated care costs.
  • While Montana’s HELP Act will require most new enrollees to pay premiums, the HELP Act limits those premiums to no more than 2% of the enrollee’s adjusted gross income. Furthermore, those living below the poverty line cannot be disenrolled from Medicaid if they do not pay their premiums (though the unpaid premiums can be a collectible debt by the state). While premium requirements will be a stretch for some low-income families, these families will not be threatened with loss of health care when they most need it.
  • Individuals will not be subject to cost sharing (co-pays) beyond current Medicaid rules. Current Medicaid programming allows plans to require cost sharing up to 5% of adjusted gross income. The Montana HELP Act also requires individuals to pay co-pays, but limits it to 3% of their adjusted gross income. This, combined with the premiums, will therefore stay below the total 5% cost sharing provided in current Medicaid.
  • CMS rejected initial waivers submitted by Indiana and Pennsylvania that made Medicaid eligibility dependent on employment or participation in certain work search activities. We know that the vast majority of those in the gap are already working; however, it is important to remember that some cannot work because they are too sick, but aren’t technically disabled, or they are taking care of children or a sick relative. The HELP Act does not have a work requirement, and thus is consistent with other approved waivers. The HELP Act does include some funding for workforce development and provides a voluntary program for new enrollees to receive training through the Montana Department of Labor and Industry.

The 1115 waiver process is an important step, and we will be closely following it. 70,000 Montanans are depending on it.

The Montana HELP Act: A New Pathway to Insure 70,000 Montanans

If you’ve been following our blog, you know that the Montana Budget and Policy Center unequivocally supports expanding Medicaid coverage in Montana. Providing affordable health care coverage to up to 70,000 Montanans who are without access right now not only improves these folks’ lives, but will also inject nearly $5 billion in federal funds into Montana’s economy. Expansion will create 12,000 jobs and it will reduce uncompensated health care costs the state.

While dozens of states have implemented straightforward Medicaid expansion, other states have taken a different approach. We know that the state legislature will need to find a compromise to pass legislation through both the Montana House and Senate. This is why we supported the Healthy Montana Plan HB249. Even though that bill failed, we still continue to push for legislation that accepts the federal funds available and expands access to the 70,000 Montanans who need it.

This week, Senator Ed Buttery introduced the Montana HELP Act (SB 405), and we believe it is a promising step forward to expanding Medicaid in Montana. This compromise legislation has bipartisan support from both chambers. It accepts federal funds, which will inject hundreds of millions of dollars into Montana’s economy. It will also provide access to affordable health care to the entire population who need it. We know how important it is to pass a policy in Montana before the legislature adjourns and this is why we will testify in support of SB405.

However, as part of any compromise, there are concerns regarding provisions of this bill. The HELP Act will charge new enrollees a premium for access to health care coverage. While the premiums will be limited to 2% of enrollees’ modified adjusted gross income, this could be a real stretch for Montana’s low-income families. Additionally, the bill requires new enrollees to pay co-pays for certain services (up to another 3% of their modified adjusted gross income). This cost sharing can add up to 5% of their modified adjusted gross income – that is the maximum allowed under federal law. The good news is that co-pays will not be applied to preventative health care, health screenings, immunizations, or generic pharmaceuticals for chronic medical conditions.

Another concern is the penalties for failure to pay premiums. For Montanans who are below 100% of the poverty line ($11,770 for an individual or $20,090 for a family of three), there is no disenrollment for nonpayment, however the unpaid premiums become a collectable debt by the state. For Montanans who are above 100% of the poverty line, failure to pay within 90 days of notice will result in disenrollment. They can be reenrolled upon payment.

Lastly, there is an asset based fee provision. However, it only applies to people who have assets in excess of: (1) $250,000 of equity in a primary residence, (2) a primary vehicle, and (3) $50,000 in additional cash or cash-equivalent assets.

Even with our concerns about the additional hurdles SB 405 places on low-income families, we will support this legislation and we hope policymakers will seriously consider this compromise. We’ve been saying it for over a year now – 70,000 can’t wait. We cannot ask our fellow Montanans to continue to wait for health care. This is too important.

Montana Loses Millions Each Day By Not Expanding Medicaid

Montana's Fading OpportunityMontana is missing out on millions of dollars every day, in addition to thousands of jobs, by not expanding the state’s Medicaid program so more Montanans can gain health coverage.

On January 1, 2014, the federal government made funds available to states that choose to expand their Medicaid programs. Because Montana’s legislature has so far refused to accept the federal funds and extend Medicaid coverage to as many as 70,000 low-income individuals, Montana has been losing as much as $1.96 million of federal funds every day.

Additionally, Montana is losing out $1.38 million in increased labor productivity from the 12,000 jobs that expansion would create. This increased labor income would also help generate $143,750 in state and local tax revenue every day. Medicaid expansion is an important opportunity for our state, and every day it is delayed Montana loses out on millions of dollars that could be used to create jobs, support our economy, and provide health care coverage to 70,000 low-income Montanans.


>> Read our full fact-sheet here.


Medicaid Expansion: A Critical Move for Montana

medexpanIn 2013, the Montana Legislature had the opportunity to accept federal funds to expand the state’s Medicaid program, a move that would provide access to health care for nearly 70,000 low- and moderate-income Montanans and boost the state’s workforce and economy. Efforts to advance legislation received bipartisan support. Unfortunately, the final compromise bill became a victim of political gamesmanship.

The fight to expand Medicaid is not over. Montana has a variety of policy options to enact expansion. The stakes are high. Tens of thousands of Montanans wait for access to much-needed health care, and Montana risks losing millions of dollars in federal support if policymakers delay the decision past the end of 2013.


>> Read the full report here.