MBPC’s Comment to Centers for Medicare and Medicaid Services

On October 14, the Montana Budget & Policy Center submitted comment to the federal Centers for Medicare and Medicaid Services (CMS) urging them to deny Montana’s request to end 12-month continuous eligibility for adult Medicaid enrollees. Roughly 17,000 Montanans risk losing coverage with the end of continuous eligibility, according to a recent analysis. This effort by the state will hurt individuals’ access to coverage, including critical preventative care, and impact Montana’s economic recovery. 

You can find MBPC’s full comment here.

Position Announcement: KIDS COUNT Coordinator

The Montana Budget & Policy Center (MBPC) is a nonprofit organization dedicated to advancing responsible tax, budget, and economic policies through credible research and analysis in order to promote opportunity and fairness for all Montanans. We work on a range of social justice issues including early childhood education, paid family and medical leave, access to quality health care, criminal justice reform, affordable housing, and investment in public education. Our team is dedicated to racial justice and creating a Montana where everyone has what they need to live their best lives.

Through the generous support of the Annie E. Casey Foundation’s KIDS COUNT national project, MBPC will assume responsibility for KIDS COUNT program in a three-state region (Montana, North Dakota, and South Dakota). MBPC will be the first KIDS COUNT organization to lead the efforts in multiple states. MBPC will produce the annual data book, publish briefs on key policy issues, and maintain web access to KIDS COUNT data for Montana, North Dakota, and South Dakota.

MBPC is seeking qualified applicants for the new KIDS COUNT Coordinator position. The KIDS COUNT Coordinator will oversee research and policy aspects of MBPC’s work as the KIDS COUNT organization for Montana, North Dakota, and South Dakota. This work will include data, research, communications, and outreach responsibilities. The KIDS COUNT Coordinator represents KIDS COUNT in the community and is the primary liaison with the national KIDS COUNT network.

Duties and Responsibilities

  • Identify data on child and family well-being; work with state administrators to develop data if necessary; prepare and load data into KIDS COUNT Data Center.
  • Conduct research on topics related to child well-being, particularly as those topics cut across traditional single-issue areas and ensure the distribution of that research to interested parties and diverse stakeholders.
  • Create data and research products, including research reports, legislative district and county-level fact sheets, and policy briefs.
  • Travel to North Dakota and South Dakota to build relationships with state agencies, tribal leaders, policymakers, and stakeholders.
  • Lead MBPC’s efforts to disseminate national KIDS COUNT data products in Montana, North Dakota, and South Dakota.
  • Serve as a point of contact with media, stakeholders, and partners on MBPC’s KIDS COUNT activities.
  • Equip diverse stakeholders with information about resources available through KIDS COUNT.
  • Provide technical assistance and support to MBPC staff on KIDS COUNT resources.
  • Represent MBPC at national KIDS COUNT meetings and conferences and on state coalitions and similar task forces.

Required Experience, Education, and Skills

  • Demonstrated commitment to racial equity, inclusion, and social justice.
  • Significant experience within a social science or data-driven field.
  • Significant field experience in quantitative research.
  • Significant experience with data and strong data management skill.
  • Sense of humor.
  • Fluency in the Microsoft Office Suite (especially Excel).
  • Excellent writing and research skills.
  • Highly developed attention to detail.
  • Organized and able to work independently.
  • Strong interpersonal skills and ability to build relationships and work effectively with a range of diverse audiences and constituencies.

You will be a highly-qualified candidate if you possess:

  • Additional software knowledge (SPSS, SAS, GIS, etc.).
  • Previous experience with policymakers, state agencies and data providers, media, and legislators.
  • Volunteer or work experience in child advocacy or an agency/institution serving children and families

 Position Details

A full job description can be found here. The ideal candidate will work full-time and be based in Helena. However, the organization may consider a different location for a truly exceptional candidate.

Salary range is $50,000 – 60,000, commensurate with experience. MBPC offers excellent benefits, including health insurance, dental insurance, retirement, and generous paid vacation, sick leave, holidays, and paid family and medical leave.

To Apply:

To apply, submit a cover letter and resume by email to:

Heather O’Loughlin, Co-Director for Research and Development, holoughlin@montanabudget.org

Initial application review will begin November 15, 2019, but applications will be accepted until position is filled.

We strongly encourage applicants from diverse communities, constituencies, and identities, including but not limited to people of all ethnic/racial backgrounds, people of all gender identities/gender expressions, people with disabilities, individuals living on low-incomes, and LGBTQ persons.

2018 State-Tribal Symposium Sponsors

The Montana Budget and Policy Center is proud to keep the symposium free for attendees in addition to offering travel assistance. We are grateful to have generous sponsors supporting the 2018 State-Tribal Policy Symposium: Advancing Investments in Indian Country and our Legislative Reception.

MBPC would like to thank the following sponsors.

 

 

 

Rural Montana Hit Harder Under Senate Health Care Plan

The Senate health care bill, the Better Care Reconciliation Act (BCRA), will result in tens of thousands of Montanans losing coverage, increased health care costs for many Montana families, and the loss of billions in federal Medicaid funds to provide coverage for Montana children, elderly, and people with disabilities. Those who are living in Montana’s rural communities are at even greater risk of increased costs and loss of coverage. The Senate took the deeply flawed House-passed American Health Care Act (AHCA) and made relatively minor adjustments to the bill’s framework. In some ways, the Senate bill is even worse than the House AHCA.

Medicaid plays a significant role in not only providing health coverage but also paying for care in rural areas. Threats to dismantle Medicaid and cut federal support will disproportionately harm rural Montanans and rural health providers, like critical access hospitals. Furthermore, rural Americans have benefited greatly from the tax credits and subsidies provided through the Affordable Care Act to access health insurance on the marketplace. While the BCRA does take into consideration the local cost of insurance (unlike the House-passed AHCA), many rural counties in Montana will still see higher costs for coverage and older Montanans will be charged more for less coverage.

Medicaid plays critical role in rural Montanans’ access to health services.

Over 216,000 Montanans access health care coverage through Medicaid, nearly half of which are children in the Healthy Montana Kids program (Montana’s children’s Medicaid and CHIP program). Montanans residing in rural counties are more likely to access coverage through Medicaid than Montanans residing in urban areas.[1] Medicaid has provided greater access to primary physicians and preventative care, such as cancer screenings, diabetes screenings, and dental services. Individuals in rural areas are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts.[2]

[popout]Nearly half (48 percent) of the 77,000 Montanans enrolled in Medicaid expansion live in rural communities.[/popout]
Montana’s bipartisan Medicaid expansion has benefited rural Montanans and rural health providers.

As of May 2017, 77,000 low-income Montanans have enrolled in Montana’s Medicaid expansion plan. Of these, roughly 48 percent reside outside of Montana’s seven largest urban areas.[3] In addition to greater access to preventative care, Medicaid expansion has also expanded access to mental health and substance use disorder treatment, helping to address the opioid and methamphetamine crises ravaging Montana’s rural communities.[4]

Furthermore, Medicaid expansion has become a critical financial lifeline for many rural hospitals. Prior to Medicaid expansion, Montana hospitals reported nearly $400 million in uncompensated care costs in 2013, with many critical access hospitals serving high numbers of uninsured Montanans feeling the greatest pressure.[5] Since the passage of Montana’s Medicaid expansion, the uninsured rate in the state has plummeted, to 7.4 percent in 2016 compared to over 15 percent in 2015.[6]  Payments to Montana health care providers have increased, and many providers are already reporting fewer uninsured patients and lower uncompensated care costs.[7] Nationally, in states that expanded Medicaid, uncompensated care costs as a share of hospital costs fell by about half between 2013 and 2015.[8] If Congress ends Montana’s Medicaid expansion, providers would face increased uncompensated care costs, putting many rural providers in financial peril. If a rural hospital closes, it hurts an entire community. 

BCRA provides woefully inadequate tax credits for rural Montanans to access marketplace health insurance.
[popout]74 percent of Montanans accessing insurance through the Marketplace live in rural areas.[/popout]
Rural Montanans constitute a higher portion of Montanans accessing health insurance through the health marketplace. In 2017, nearly three-fourths of Montana consumers accessing coverage through the marketplace reside in rural areas.[9] This is due, in part, to a greater share of rural Montanans without access to employer-provided health insurance. The ACA’s tax credits and subsidies take into account factors such as geographic area and income level to ensure affordability. This is particularly important for rural communities, where premiums tend to be higher because of low population density and higher medical care costs.

The Senate GOP plan dramatically changes the structure of tax credits, although it does take into account geographic region and income. The BCRA, instead, will be most devastating for older Montanans, many of whom live in rural communities. For example, a 60-year-old man from Chouteau County with an income of $30,000 would receive nearly $1,330 less in tax credits under the Senate bill than under current law. Factoring in premiums under BCRA, the total cost of insurance on the marketplace would be $6,350 more than coverage under the ACA, a 255 percent increase in cost.[10]

Premiums caps under the BCRA will vary by age and will range in 2020 from 2.4 percent of income for a household below the poverty level (less than $12,500 in 2020), to 17.4 percent of income for a 60-year-old at 350 percent of poverty ($43,750). The same 60-year-old Montanan with a $30,000 salary from the example above would pay 29 percent of his income ($8,840) under the BCRA, compared to just eight percent under the ACA.[11]

 BRCA county graphic

Conclusion

Montana’s rural communities play an important role in our state’s economy. Medicaid coverage and access to health care tax credits and subsidies provide many Montana families – especially those in rural Montana – the ability to access affordable health services. Montana’s Medicaid expansion has provided much-needed support for rural health providers, which allow hospitals to expand services, increase hours, or simply keep their doors open. While there are small differences between the House-passed AHCA and the Senate BCRA, both are fundamentally flawed and put the health of rural Montanans and our communities in jeopardy.

 

 

2017 State-Tribal Legislative Impacts

State and federal budgets both play a significant role in relieving poverty, promoting health, and building economic opportunity in Indian Country. Both also have a substantial impact on the lives of American Indians living on- and off-reservation in Montana. Recently, the 2017 Montana legislature considered a number of bills that held direct implications for American Indians in our state. Below is an overview.

 

Bill No. Title Outcome Page
HB 2 Investment in Indian Country Economic Development (ICED) Passed, OTO 2
HB 2 Investment in Tribal College Assistance Program Passed 2
HB 6 Renewable Resource Grants Passed as amended 2
HB 37 Revise Montana Indian Language Preservation Program Passed 3
HB 108 Allocate Wild Buffalo Licenses to Tribes for Traditional Purposes Passed 3
HB 113 Indian Language Immersion Funds Revision Passed 3
HB 114 Prohibit the Sale or Trade of Cultural Patrimony and Sacred Objects Failed 4
HB 118 Revise and Provide Additional Funding for Suicide Prevention Activities Passed as amended 4
HB 185 Montana Promise Act to Increase College Affordability Passed as amended 4
HB 333 Help Save Lives from Overdose Act Passed as amended 5
HB 391 Montana Earned Income Tax Credit Passed as amended 5
HB 473 Revise Highway Revenue Laws Passed as amended 5
HB 605 Montana Reservation Economic Development Act Failed 6
HB 622 Generally Revise Laws Related to Invasive Species Passed as amended 6
HB 655 Revising Employment Incentive Laws for Hiring American Indians Failed 6
SB 287 Reallocation of Funds Related to the Blackfeet Water Compact Passed 7
SB 309 Revise Economic Development Laws Related to Indian Country, Tourism Passed as amended 7
SB 310 Revise Laws Related to Criminal Jurisdiction on the Flathead Indian Reservation Passed 7
SB 319 Allow Individuals to Wear Traditional Regalia, Objects of Cultural Significance Passed 8
SB 328 Revisions to Alcohol Tax Laws Failed 8
SB 354 Revisions to Tobacco, Nicotine, and Tobacco Product Taxes for Healthcare Services Failed 8
HR 3 Resolution in Support of Permanent Authorization of the Indian Healthcare Improvement Act Passed 8
SR 57 Resolution in Support of Permanent Authorization of the Indian Healthcare Improvement Act Passed 8
HJ 5 Resolution Recognizing the Anniversary of the Fort Robinson Breakout Passed 9
SJ 3 Study of Tribal Resources for Tribal Members Involved in the State Criminal Justice System Passed 9
SJ 20 Study of Intractable Unemployment in High-Poverty Counties Passed 9

 

Indian Country Economic Development (ICED) Program

Bill Number: HB 2

Outcome: PASSED, ONE-TIME-ONLY FUNDING

The Indian Country Economic Development (ICED) programs provide funding for tribal government priority projects (i.e., tribal enterprise feasibility studies), the Native American Business Advisors (NABA) program, and the Indian Equity Fund small business grants to individual entrepreneurs. Despite the Governor’s request to move ICED to the base budget, the legislature funded ICED on a one-time-only basis at $1.6 million for the 2019 biennium. To read more about the value of the ICED programs, see MBPC’s recent report, “Economic Development In Indian Country: A State Investment with Continued Returns.”[1]

 

Tribal College Assistance Program (TCAP)

Bill Number: HB 2

Outcome: PASSED

Montana will continue to reimburse tribal colleges for the educational services they provide to resident full-time, non-beneficiary students (non-Indians and anyone who is not a member or first-generation descendant of a federally-recognized tribe). For many years, tribal colleges in Montana did not receive funding to support the education services they provide to non-beneficiary students and were left to absorb the cost in their budgets. To help offset this cost, the 1995 legislature established the Tribal College Assistance Program, which became permanent in 1997. Montana is one of only three states that provide some funding for non-beneficiary students. Funding for the 2019 biennium is $1.682 million. To learn more about the benefits that tribal colleges bring to Montana, read MBPC’s report, “An Outstanding Return on Investment: Tribal Colleges and Their Contributions to Montana.”[2]

 

Renewal Resource Grants

Bill Number: HB 6

Sponsor: Jim Keane, HD 73

Outcome: PASSED AS AMENDED

This bill appropriates funding for renewable resource grants for numerous water resources projects, including several located on Indian reservations across the state. HB 6 also specifies conditions for application and dispersal of grant funds and identifies projects of highest priority. These include wastewater collection system improvement; irrigation system, riverbank erosion, and canal rehabilitation; water storage and distribution improvements; well and aquifer evaluations; and flood studies, among others.

 

Revise Montana Indian Language Preservation Program

Bill Number: HB 37

Sponsor: Jonathan Windy Boy, HD 32

Outcome: PASSED

HB 37 provides $1 million to extend the Montana Indian Language Program (MILP), which provides support to Montana tribes to preserve and perpetuate tribal languages in the form of spoken, written, sung, and signed language. Read MBPC’s report, “Continued Preservation of Tribal Languages in Montana,” to learn more about MILP.[3] Another related bill, SB 261, puts in place certain budgetary cuts, should levels of revenue come in lower than expected. If revenue comes in below $2.18 billion in FY17 (roughly $32.5 million below projections), SB 261 imposes a $125,000 cut in FY18 and $125,000 in FY19 to MILP. The state treasurer will determine final revenue levels for FY17 in August of 2017 to determine what cuts, if any, are necessary.

 

Allocate Wild Buffalo Licenses to Tribes for Traditional Purposes

Bill Number: HB 108

Sponsor: Bridget Smith, HD 31

Outcome: PASSED

This bill requires Montana Fish, Wildlife & Parks to issue special free-of-charge licenses to tribes in Montana when there are sufficient bison numbers, indicated by the department issuing forty or more special wild bison licenses. A license will be issued to two tribal members from each reservation and the Little Shell to hunt wild bison during the regular season in accordance with department rules. Bison taken with these special licenses must be used for traditional purposes, which are defined as “the harvesting of buffalo by Plains Indians through utilitarian and spiritual practices handed down from generation to generation to obtain food, shelter, and clothing and to conduct ceremonies and celebrations.”

 

Indian Language Immersion Funds Revision

Bill Number: HB 113

Sponsor: Edward Greef, HD 88

Outcome: PASSED

Montana school districts are encouraged to create Indian language immersion programs in collaboration with other school districts, the Montana digital academy, tribal governments, and tribal colleges. They are also encouraged to utilize the materials produced in the Montana Indian Language Program and to employ tribal language and culture specialists as teachers. As a result of the increased costs, school districts that create language immersion programs are entitled to additional American Indian achievement gap, Indian Education for All, and quality educator payments. HB 113 allows districts to use these payments as matching funds for federal or private funding sources.

 

Prohibit the Sale or Trade of Cultural Patrimony and Sacred Objects

Bill Number: HB 114

Sponsor: George Kipp, III, HD 15

Outcome: FAILED

HB 114 would have prohibited the sale or trade of any object that has ongoing historical, traditional, or cultural importance central to an Indian tribe, group, or culture itself. It also would have prohibited the sale or trade of sacred objects, defined as those necessary to traditional Native American ceremonials leaders’ practice of their ceremonies by their present-day participants and which requires a ceremonial transfer to be given from one person to another. Individuals knowingly buying, selling, exchanging, distributing, marketing, or otherwise conducting a commercial transaction for profit would have been guilty of a misdemeanor crime and subjected to a fine equal to the value of the object or sentenced to imprisonment in the county jail for less than six months, or both.

 

Revise and Provide Additional Funding for Suicide Prevention Activities

Bill Number: HB 118

Sponsor: Jonathan Windy Boy, HD 32

Outcome: PASSED AS AMENDED

Montana has had one of the highest suicide rates in the nation for nearly forty years. As MBPC recently reported in “Indian Country Suicide Prevention: A Critical Investment for Our Communities,” American Indians in Montana have a disproportionately higher suicide rate when compared to non-Indians.[4] Most astounding is the fact that in Montana, American Indian youth ages 11 to 17 are four times more likely to die by suicide than their white counterparts. To combat this prolonged public health crisis, the legislature passed HB 118, allocating $1 million to statewide suicide prevention efforts. Of this, $250,000 will go specifically to implementing the action steps outlined in the Montana Native Youth Suicide Reduction Strategic Plan.[5]

 

Montana Promise Act to Increase College Affordability

Bill Number: HB 185

Sponsor: Shane Morigeau, HD 95

Outcome: PASSED AS AMENDED

The Montana Promise Act establishes a grant program that aims to reduce or eliminate tuition costs in order to increase college affordability and attainment for Montana residents attending community and tribal colleges in the state. Although the legislature passed a law creating the grant program, they did not appropriate any money for it. However, the law gives the Office of the Commissioner of Higher Education the ability to accept private or out-of-state public donations for the grants. If funded in the future, the program would provide grants to first and second-year Montana resident students enrolled at least half-time and taking courses that lead to an associate’s degree, professional credential, or the ability to transfer to another Montana institution of higher education.

 

Help Save Lives from Overdose Act

Bill Number: HB 333

Sponsor: Frank Garner, HD 7

Outcome: PASSED AS AMENDED

Tens of thousands of Americans die from overdose each year, prompting the Center for Disease Control to declare that opioid-related deaths are a national epidemic. Because opioid antagonist drugs, or medication that blocks the effects of opioids, has proven highly effective in countering the effects of opioid overdose, the Save Lives from Overdose Act aims to increase the number of lives saved by: (1) providing the broadest possible access to lifesaving opioid antagonist medication; (2) facilitating the availability and use of opioid antagonist medication by providing professional, civil, and criminal immunity to people who prescribe, dispense, distribute, or administer an opioid antagonist; and (3) encouraging people to seek medical treatment by providing immunity from prosecution for certain criminal offenses for people who seek or receive treatment. This act specifically allows contract physicians at urban Indian health clinics to dispense opioid antagonist drugs to qualified patients of the clinic.

 

Montana Earned Income Tax Credit

Bill Number: HB 391

Sponsor: Tom Jacobson, HD 21

Outcome: PASSED AS AMENDED

This bill establishes a state earned income tax credit (EITC) based on the federal EITC qualification requirements. Like other state citizens, eligible American Indians in Montana who file a state tax return may claim the credit, which is set at 3% of the federal EITC. Learn the details in MBPC’s recent report, “HB 391 – The Montana Earned Income Credit: Helping Montana’s Working families and Economy.”[6]

 

Revise Highway Revenue Laws

Bill Number: HB 473

Sponsor: Frank Garner, HD 7

Outcome: PASSED AS AMENDED

This bill revises highway funding and expenditure laws. It provides for an increase in the fuel tax and special fuel tax, which will result in an increase to the per capita calculation upon which the state-tribal gas tax agreements are based.

 

Montana Reservation Economic Development Act

Bill Number: HB 605

Sponsor: Greg Hertz, HD 12

Outcome: FAILED

This bill would have created a tax benefit for new or expanded businesses located on or adjacent to an Indian reservation in Montana. The tax credit would have been calculated according to five percent of the gross wages paid in general for employees making $15 an hour or more, with a tax credit increase to twenty percent for employing enrolled tribal members or veterans. The maximum credit possible to claim under this bill would have been $2,000 per employee per year and could not exceed the taxpayer’s income tax liability. HB 605 would have also created a small business investment tax credit with the goal of encouraging investment in small businesses and increasing the number of high-wage jobs on or adjacent to Indian reservations in Montana.

 

Generally Revise Laws Related to Invasive Species

Bill Number: HB 622

Sponsor: Mike Cuffe, HD 2

Outcome: PASSED AS AMENDED

This revises existing laws related to controlling the spread of invasive species. First, it creates a twenty-two member Invasive Species Council within the Montana Department of Natural Resources and Conservation to advise the Governor on a science-based, comprehensive program to identify, prevent, eliminate, reduce, and mitigate invasive species in Montana and to coordinate with public and private partners to develop and implement statewide invasive species strategic plans. HB 622 also creates the Upper Columbia Conservation Commission to protect the aquatic environment in tributaries to the Columbia River from the threat of invasive species. Representatives from each reservation in Montana will sit on the Invasive Species Council and a representative from the Confederated Salish and Kootenai Tribes will be appointed to the Upper Columbia Conservation Commission. Additionally, HB 622 revises the locations and timing of inspections in the statewide invasive species management area, as well as authorizing counties within the Columbia River basin to create invasive species control ordinances. Furthermore, it establishes the Missouri River Containment and Quarantine Program and the Upper Columbia Pilot Program. Finally, it expands the penalties for knowingly violating invasive species management rules and significantly increases fines.

 

Revising Employment Incentive Laws for Hiring American Indians

Bill Number: HB 655

Sponsor: George Kipp, III, HD 15

Outcome: FAILED

HB 655 proposed tax credit incentives for private employers who hire American Indians in Montana. These tax credits would have been based on a portion of the wages paid to enrolled members of a state or federally-recognized tribe in Montana when: (1) most of the services performed by the employee are performed in Montana; (2) the wages paid to the employee on which the tax credit is based includes wages paid plus any contribution paid by the employer for health insurance to the employee’s health insurance coverage; (3) the employee is not a five percent owner or employed in an enterprise involved in gaming; (4) the employee worked fifty-two weeks, less vacation or sick leave, for the employer in the tax year for which the credit is claimed; and (5) the tax credit is equal to the Indian employment credit an employer may claim under 26 U.S.C. 45A or $1,000, whichever is greater. Finally, the credit could not have exceeded the taxpayer’s income liability.

 

Reallocation of Funds Related to the Blackfeet Water Compact

Bill Number: SB 287

Sponsor: Llew Jones, SD 9

Outcome: PASSED

SB 287 fulfills a portion of the Blackfeet Tribe’s water rights compact agreement, transferring $14 million from the tribe’s compact infrastructure account to their mitigation account. The funds will be spent according to the Birch Creek agreement.

 

Revise Economic Development Laws Related to Indian Country, Tourism

Bill Number: SB 309

Sponsor: Lea Whitford, SD 8

Outcome: PASSED AS AMENDED

As MBPC recently reported in, “Tourism Could Be an Economic Driver in Indian Country With Focus and Investment,” tourism is one of Montana’s leading industries, creating thousands of jobs and contributing billions of dollars to our state’s economy each year.[7] SB 309 aims to increase tourism in Indian Country and Montana by: (1) creating a specific Indian Country Tourism Region from within the state’s existing tourism regions; (2) designating a member of the Governor’s Tourism Advisory Council (TAC) to be a tribal member from the private sector; and (3) recognizing the State Tribal Economic Development Commission as the point of contact to work collaboratively with TAC to expand tourism in Indian Country.

 

Revise Laws Related to Criminal Jurisdiction on the Flathead Indian Reservation

Bill Number: SB 310

Sponsor: Lea Whitford, SD 8

Outcome: PASSED

SB 310 amends existing state law passed in 1963 to allow the Confederated Salish and Kootenai Tribes (CSKT) to withdraw from Public Law 83-280, which enabled the state of Montana to assume criminal and civil jurisdiction on the Flathead Reservation. The amendment strikes a single word from the existing law (2-1-306 MCA) to now read that the CSKT “may, by tribal resolution, withdraw consent to be subject to criminal misdemeanor jurisdiction of the state of Montana.”

 

Allow Individuals to Wear Traditional Regalia and Objects of Cultural Significance

Bill Number: SB 319

Sponsor: Jen Gross, SD 25

Outcome: PASSED

To further Montana’s constitutional recognition of the “distinct and unique cultural heritage of the American Indians and the state’s commitment to preserving the American Indians’ cultural integrity,” SB 319 bars a state agency or local government from prohibiting individuals from wearing traditional tribal regalia or objects of cultural significance at certain public events, including awards ceremonies, graduation ceremonies, and public meetings.

 

Revisions to Alcohol Tax Laws

Bill Number: SB 328

Sponsor: Lea Whitford, SD 8

Outcome: FAILED

SB 328 would have increased the excise tax collected at the time of the sale and delivery of liquor, beer, wine, and hard cider in Montana. It also proposed an additional tax on certain table wine. Had this bill passed, it would have increased the amounts tribes receive through the state-tribal revenue sharing agreements.

 

Revisions to Tobacco, Nicotine, and Tobacco Product Taxes for Healthcare Services

Bill Number: SB 354

Sponsor: Mary Caferro, SD 41

Outcome: FAILED

SB 354 would have increased the tobacco and tobacco products tax, generating increased revenue that would have gone towards providing a wage increase and additional employer expenses for direct care workers who provide Medicaid services, as well as for tobacco use prevention or cessation programs administered by the Montana Department of Public Health and Human Services. The increased revenue was intended to increase Medicaid services and Medicaid provider rates and not to supplant the state’s general fund in the trended traditional level of appropriation for Medicaid services and Medicaid provider rates. Like SB 328, had this bill passed, it would have increased the amounts tribes receive through the state-tribal revenue sharing agreements.

 

Resolution in Support of Permanent Authorization of the Indian Healthcare Improvement Act

Bill Numbers: HR 3, SR 57

Sponsors: Jonathan Windy Boy, HD 32; Lea Whitford, SD 8

Outcome: PASSED

These resolutions urge President Trump and the United States Congress to retain permanent reauthorization of the Indian Healthcare Improvement Act (IHCIA) when making changes to the Patient Protection and Affordable Care Act (ACA). The IHCIA was passed in 1976, declaring that it is the goal of the United States to provide the highest possible health status to American Indians and to provide the Indian Health Services with all the resources necessary to affect this goal. IHCIA has been reauthorized numerous times until 2010, when its authorization was made permanent by the passage of the ACA. HR 3/SR 57 stresses the importance of IHCIA and the necessity that its reauthorization remain permanent despite other changes made to the ACA. See our report, “Medicaid Expansion in Indian Country: Effective Strategies for Outreach and Enrollment,” to learn more about IHCIA and its relationship to Medicaid Expansion in creating a more solid foundation for ensuring the health of American Indians in Montana.[8]

 

Resolution Recognizing the Anniversary of the Fort Robinson Breakout

Bill Number: HJ 5

Sponsor: Kelly McCarthy, HD 49

Outcome: PASSED

HJ 5 officially recognizes 138th anniversary of the Northern Cheyenne’s breakout from Fort Robinson, Nebraska and the historical significance of the struggles that led it. It also commends the young participants in the Fort Robinson Memorial Breakout Run, which retraces the 400-mile trek through Nebraska, South Dakota, Wyoming, and Montana.

 

Study of Tribal Resources for Tribal Members Involved in the State Criminal Justice System

Bill Number: SJ 3

Sponsor: Cynthia Wolken, SD 48

Outcome: PASSED

A 2015 study from the Commission on Sentencing researched Montana’s criminal justice system and found that although American Indians comprised just seven percent of the state’s population, they made up 27 percent of all arrests related to failure to appear for court events or for violations of conditions related to community supervision. The interim study authorized by SJ 3 will explore how the state could transfer tribal members who are subject to state supervision from state or county custody to tribal custody; allow tribal members to fulfill conditions of state court-ordered programming by participating in programs offered by the tribes or tribal organizations; and create a grant program to enable the Office of the State Public Defender to enlist tribal defense attorneys in place of an appointed public defender for tribal members. The study is to be concluded by September 15, 2018.

 

Study of Intractable Unemployment in High-Poverty Counties

Bill Number: SJ 20

Sponsor: Jason Small, SD 21

Outcome: PASSED

Montana’s overall unemployment rate was 4.0 percent in December 2016, compared to a national average of 4.7 percent. This comparison is problematic because it glosses over the high-unemployment and high-poverty areas scattered across the state, including on Indian reservations. SJ 20 seeks to understand the factors involved in creating the disparities. The resolution directs researchers to examine the location and placement success of job services and apprenticeship programs or other training opportunities. In addition, researchers will review course offerings at community and tribal colleges as they relate to local employer needs and activities, and assess the availability of Internet and broadband and other components that enable workers to work from home.

 

To read the full text of each bill, visit leg.mt.gov.

 

 

Rural Montana Hit Harder Under House-Passed Health Care Plan

The House-passed health care bill, the American Health Care Act (AHCA), will result in tens of thousands of Montanans losing coverage, increased health care costs for many Montana families, and the loss of billions in federal Medicaid funds to provide coverage for Montana children, elderly, and people with disabilities. Those who are living in Montana’s rural communities are at even greater risk of increased costs and loss of coverage.

Medicaid plays a significant role in not only providing health coverage but also paying for care in rural areas. Threats to dismantle Medicaid and cut federal support will disproportionately harm rural Montanans and rural health providers, like critical access hospitals. Furthermore, rural Americans have benefited greatly from the tax credits and subsidies provided through the Affordable Care Act to access health insurance on the marketplace. The proposed tax credit under the House plan would no longer factor in regional disparities in costs of insurance and represent dramatic cuts to assistance for individuals, particularly older Montanans.

Medicaid plays critical role in rural Montanans’ access to health services.

Over 240,000 Montanans access health care coverage through Medicaid, nearly half of which are children in the Healthy Montana Kids program (Montana’s children’s Medicaid and CHIP program). Montanans residing in rural counties are more likely to access coverage through Medicaid than Montanans residing in urban areas.[1] Medicaid has provided greater access to primary physicians and preventative care, such as cancer screenings, diabetes screenings, and dental services. Individuals in rural areas are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke, than their urban counterparts.[2]

[popout]Nearly half (48 percent) of the 77,000 Montanans enrolled in Medicaid expansion live in rural communities.[/popout]
Montana’s bipartisan Medicaid expansion has benefited rural Montanans and rural health providers. Over 77,000 low-income Montanans have enrolled in Montana’s Medicaid expansion plan. Of these, roughly 48% reside outside of Montana’s seven largest urban areas.[3] In addition to greater access to preventative care, Medicaid expansion has also expanded access to mental health and substance use disorder treatment, helping to address the opioid and methamphetamine crises ravaging Montana’s rural communities.[4]

Furthermore, Medicaid expansion has become a critical financial lifeline for many rural hospitals. Prior to Medicaid expansion, Montana hospitals reported nearly $400 million in uncompensated care costs in 2013, with many critical access hospitals serving high numbers of uninsured Montanans feeling the greatest pressure.[5] Since the passage of Montana’s Medicaid expansion, the uninsured rate in the state has plummeted, to 7.4 percent in 2016 compared to over 15 percent in 2015.[6]  Payments to Montana health care providers have increased, and many providers are already reporting fewer uninsured patients and lower uncompensated care costs.[7] Nationally, in states that expanded Medicaid, uncompensated care costs as a share of hospital costs fell by about half between 2013 and 2015.[8] If Congress ends Montana’s Medicaid expansion, providers would face increased uncompensated care costs, putting many rural providers in financial peril. If a rural hospital closes, it hurts an entire community.

AHCA provides woefully inadequate tax credits for rural Montanans to access marketplace health insurance.
[popout]74 percent of Montanans accessing insurance through the Marketplace live in rural areas.[/popout]
The House GOP plan dramatically changes the structure of tax credits, and does not take into account geographic region and income. For example, many rural Montanans accessing coverage through the marketplace will see costs increase more than those in more urban areas, such as Missoula or Billings.[10]Rural Montanans constitute a higher portion of Montanans accessing health insurance through the health marketplace. In 2017, nearly three-fourths of Montana consumers accessing coverage through the marketplace reside in rural areas.[9] This is due, in part, to a greater share of rural Montanans without access to employer-provided health insurance. The ACA’s tax credits and subsidies take into account factors such as geographic area and income level to ensure affordability. This is particularly important for rural communities, where premiums tend to be higher because of low population density and higher medical care costs.

How will AHCA impact MT

The AHCA will be most devastating for older Montanans wanting to stay in their rural hometowns. Statewide, Montana’s rural communities tend to be older and sicker. For example, a 60-year-old man from Chouteau County with an income of $30,000 would receive nearly $8,140 less in tax credits under the House bill than under current law. Factoring in premiums under AHCA, the total cost of insurance on the marketplace would be $13,170 more than coverage under the ACA, a 531 percent increase in cost.[11]

Conclusion

Montana’s rural communities play an important role in our state’s economy. Medicaid coverage and access to health care tax credits and subsidies provide many Montana families – especially those in rural Montana – the ability to access affordable health services. Montana’s Medicaid expansion has provided much-needed support for rural health providers, which allow hospitals to expand services, increase hours, or simply keep their doors open. The House-passed health care bill puts the health of rural Montanans and our communities in jeopardy.

 

Indian Country Suicide Prevention: A Critical Investment for Our Communities

Indian Country Suicide Prevention Needs an Investment

Suicide prevention programs can be a critical component to lowering rates of suicide and improving health outcomes. Given the high rate of suicide in Montana, the legislature should prioritize investments in suicide prevention programs, particularly those focused on American Indians, American Indian youth, and veterans.

Suicide in Montana

For almost forty years, Montana has had one of the highest suicide rates in the country. In 2014, the state ranked first in the nation.[1] Nationally, whites have the highest rate of suicide, followed by American Indians.[2] In Montana, this trend is reversed. Between 2014-2015, the American Indian suicide rate was 35.5 (per 100,000 people) compared to 28.1 for whites.[3] Further, Montana youth ages 11 to 17 are more than twice as likely to commit suicide than youth nationally. Astonishingly, American Indian youth in Montana are almost four times more likely to die by suicide than their white counterparts.[4] Additionally, between January 1, 2014 and March 1, 2016, 19 percent of American Indian suicides were committed by veterans.[5]

Table 1 below provides a comparative breakdown of additional suicide statistics in Montana   for the years 2005-2014. This data indicates that a focused investment in suicide prevention in Montana and Indian Country is needed in order to address this prolonged public health issue.

Table 1. Montana Suicide Rates (by race, gender, and age, per 100,000 people)[6],[7]

  Race Male (all ages) Female (all ages) Male Youth (age 11-17) Female Youth (age 11-17)
American Indian 28.2 43.3 14.2 23.5 29.0
White 21.1 33.9 8.6 9.6 4.2

 

Youth suicidal risk assessments for 2015 also show that urban-residing American Indian youth consistently outscored reservation-residing American Indian youth in risk behaviors such as seriously considering, planning, and attempting suicide.[8]

Investing in Suicide Prevention is Necessary

Suicide continues to be a major public health issue for Montana. Investing in suicide prevention should be among the state’s top priorities, with a specific focus on American Indians, American Indian youth, and veterans in particular.

Position Announcement: Policy Analyst

MBPC is seeking a policy analyst to engage in research, analysis, and advocacy on state fiscal policies related to taxes, the state budget and economic development.

Analysis will span a range of issue such as the adequacy and fairness of federal and state governments’ revenue structures, federal and state budgets and their impact on vulnerable populations, the unique budgetary relationship between American Indian tribes and the state, income supports for the working poor, access to health care, and education funding.

The position requires strong analytic skills, self-motivation, and the ability to communicate effectively with a variety of target audiences, including policymakers, the media, and ally organizations across the state. The Policy Analyst will report directly to the Co-Director of Research and Development.

View our full job description.

Tourism Could Be an Economic Driver in Indian Country With Focus and Investment

Tourism is one of Montana’s leading industries, creating thousands of jobs and contributing billions of dollars to our state’s economy annually.[1] Tourism activities in Indian Country continue to grow and represent a significant opportunity to expand economic development on reservations and across the state.

Senate Bill 309 would help increase tourism in Indian Country and Montana by: (1) creating a specific Indian Country Tourism Region from within the state’s existing tourism regions; (2) designating one existing member of the Governor’s Tourism Advisory Council (TAC) to be a tribal member from the private sector; and (3) recognizing the State Tribal Economic Development Commission as the point of contact to work collaboratively with TAC to expand tourism in Indian Country. Altogether, these minor but important changes will help tribes and the state maximize the benefits of tourism in Montana.

Tourism Provides Significant Boost to Montana’s Economy

In 2015, 11.7 million people visited Montana, spending $3.66 billion and contributing an estimated $5.15 billion to the overall Montana economy in the form of direct, indirect, and induced spending.[2]
[popout]In 2016, 12.3 million visitors spent an average of $146.91 per day, over 4.42 nights, generating:

52,630 Jobs

$4.8 Billion in Goods & Services

$194 Million in State & Local Taxes[/popout]
Preliminary numbers for the following year show that the number of visitors increased to 12.3 million in 2016. Each visitor spent an average of $147 a day and stayed between four and five nights. This supported nearly 53,000 jobs across many industry sectors, produced $4.8 billion in goods and services sold, and generated $194 million in state and local taxes.[3] In 2016, visitor spending accounted for eight percent of all jobs in Montana, fifteen percent of all service industry jobs, and eight percent of all retail jobs.[4]

Businesses like gas stations, restaurants, hotels, and retail stores most directly benefit from tourism. In 2016, tourists spent the greatest share of their dollars on gasoline/diesel. Restaurants and bars saw the second greatest share, followed by licenses and entrance fees, and then sleeping accommodations.[5] A preliminary breakdown of tourist spending by category for 2016 is reflected in the chart on the following page.

Data compiled for 2013 shows the highest-spending visitors to Montana were those who came to participate in outdoor recreational activities. These visitors tended to stay for about ten days, almost twice as long as all other visitors, and on average spent $293 per day.[6] In 2015, high-spenders stayed for six nights and spent an average of $351 per day.[7]

Research indicates that consistently the main attractant for visitors to Montana is outdoor recreation, with the primary draws being Glacier National Park and Yellowstone Park. This is followed by recreation in mountains, forests, and open spaces outside of the parks.[8]

In 2016, the most popular activities visitors engaged in were, in the following order: day hiking, wildlife watching, nature photography, fishing, birding, river rafting, road/mountain biking, skiing, and horseback riding.[9]

Data for 2012-2014 shows that thirteen percent of visitors to Montana came to experience American Indian history and culture.[10] This means that between 2012-2014, a total of approximately 4.2 million visitors—or 1.4 million visitors annually—were drawn to Montana for reasons directly related to American Indians.[11] This is a sizeable number that could increase with focus and investment, thereby benefitting Indian Country and the rest of the state—because what is good for Indian Country is good for Montana.

In a comprehensive 2016 study of more than 6,200 leisure travelers representing 300 national and international key markets feeding into the Montana tourism industry, 46.5 percent of respondents reported that they would be interested in coming to Montana to visit American Indian historical or cultural sites.[12] Expected spending by this group of respondents ranked sixth, coming in above segments visiting Lewis and Clark-related historical sites, Glacier and Yellowstone National Parks, and geological/dinosaur-related historical sites. Furthermore, 35 percent of respondents rated “Historical attractions” as an “Extremely important” attribute in selecting travel destinations. This “history buff” segment represents over a third of the overall population of Montana’s tourism target market.[13]

Senate Bill 309 would help bridge the gap in developing this promising niche market and bringing more of these travelers into our state.

Focus and Investment in Indian Country Tourism

Senate Bill 309 aims to increase tourism in Indian Country and Montana. Many tribes are seeking to diversify from single-revenue generating assets like agriculture, coal, or timber to include more emphasis on tourism. From hotels, campgrounds, gas stations, guided hunts, and exhibitions of traditional culture, several tribes have already undertaken a variety of economic development efforts focused on tourism and others are planning to do more in the future.

In addition to the efforts and enterprises undertaken by tribal governments there are also several individual Indian-owned businesses working to draw visitors to their communities. These businesses offer an array of products and services including activities like white water rafting, overnight camping in tipis and cabins, and guided cultural tours of tribal homelands.

Senate Bill 309 would help maximize the benefits of tourism to enhance reservation economies by supporting the growth of local businesses and increasing employment opportunities.

SB 309 focuses on Indian Country by creating a specific Indian Country Tourism Region from within the state’s existing tourism regions. Unquestionably, local tribal members, governments, and business owners are in the best position to understand and identify the unique local landscapes, cultures, recreational opportunities, and events that will help increase tourism in their communities.

SB 309 also designates one member of the Governor’s twelve-seat Tourism Advisory Council (TAC) to be a tribal member from the private sector. Currently, the state of Montana is divided into six tourism regions: Glacier Country, Central Montana, Missouri River Country, Southeast Montana, Yellowstone Country, and Southwest Montana. Private sector travel industry representatives from each tourism region serve on TAC, with at least one member being from among tribal governments.[14]

Privately owned businesses and tribal government-run enterprises differ in function and aim. The addition of a tribal member business owner on a board comprised of other private sector experts in their respective fields is important in balancing and complementing the perspective of the tribal government official.

Perhaps most importantly, SB 309 would task the State Tribal Economic Development (STED) Commission to work in conjunction with TAC to oversee the use of proceeds to expand tourism activities in Indian Country. This is a natural pairing, as both the STED Commission and TAC are partnering organizations within the Montana Office of Tourism and Business Development.[15] Furthermore, the STED Commission is responsible for assisting, promoting, developing, and proposing recommendations for accelerating on-reservation economic development.

Because the STED Commission is comprised of eleven representatives from the eight tribal governments in Montana, it is intimately familiar with the most promising existing and prospective economic development projects in Indian Country, including those related to tourism. Therefore, the STED Commission is ideally positioned to lead the charge in working collaboratively with TAC to successfully expand tourism in Indian Country.

SB 309 is Good for Indian Country Tourism, Good for Montana

Ultimately, the three minor but impactful proposals in SB 309 will allow for a more focused and collaborative approach to increasing tourism in Indian Country and Montana.

142,000 Montanans Face Uncertainty of Health Coverage With Threat of ACA Repeal

Through access to health coverage under the Affordable Care Act (ACA), Montana’s uninsured rate has dropped from 20% in 2012 to 7.4% in 2016, with thousands of Montanans accessing health coverage through the health marketplace.[i] Congress and President-elect Trump, however, have stated their intent to repeal the ACA in early 2017, without simultaneously putting in place any replacement.[ii] This effort could have disastrous impacts on Montana, leading to 142,000 fewer Montanans with health coverage than if health reform were left in place. At the greatest risk are the over 61,000 Montanans who gained access to affordable health care coverage through Montana’s Medicaid expansion plan.

In the past six years, 12.8 million Americans have gained access to health care coverage.[iii] Repealing the ACA without including a clear replacement that ensures continued access to care poses a significant threat to the economy, and creates uncertainty for millions of Americans.

Montanans Deserve Answers About Future Health Care Coverage

While Congress and President-elect Donald Trump have previously stated their intent to “repeal and replace” the ACA, it appears that Congress intends to move forward with repeal of ACA that will not include a plan for replacement.

Americans have a right to be concerned about the seriousness of plans to put in place any replacement. Since the enactment of the ACA in 2010, Congress has taken over 60 votes to repeal ACA, but it has never voted on any replacement proposal. Repealing the ACA without a replacement plan endangers the health and livelihood of thousands of Montanans.

While this report focuses primarily on the impact of ACA repeal on those who have gained access to coverage through Medicaid expansion – those who are most at risk of losing health coverage – we acknowledge that repeal of ACA also threatens the existing health insurance marketplace that has provided over 52,000 Montanans access to health insurance at more affordable rates, greater consumer protections for those obtaining insurance through employers, and improved coverage for seniors for vital prescriptions drugs through Medicare. These Montanans also face great uncertainties in the future of their health care, without a clear replacement for ACA articulated. Because Congress’ current proposal will repeal ACA without replacement, this report does not take into account the impact of a yet-to-be developed replacement.

Montana Families Face Uncertainty and Disastrous Consequences of ACA Repeal

Prior to the ACA, a staggering one in five Montanans did not have health insurance, with the overall uninsured rate hovering around 20 percent of the total adult population. Today, that uninsured rate has dropped by more than half, to just 7.4 percent, nearly a third of what it was before the ACA (see Chart 1).[iv]

Should Congress repeal the ACA, studies show that approximately 142,000 Montanans would lose health insurance.[v] National studies show that this loss in coverage would occur primarily for families with at least one worker and among individuals without college degrees. Without any of the ACA’s provisions, the number of uninsured Montanans could jump to 227,000.[vi]

Of these 142,000 Montanans losing coverage, 23,000 have accessed subsidies and tax credits to make health insurance more affordable.[vii] In 2016, those that purchased health insurance through the federal health marketplace received an average of $306 in advance premium tax credits, covering 73% of the cost of monthly premiums for insurance.[viii] With the repeal of the ACA, these individuals face the risk and uncertainty of no future financial support to help defray the cost of insurance.

 

Repeal could cause a greater number of uninsured Montanans than before the ACA was enacted (See Chart 2). In addition to coverage loss to those who have gained insurance through Medicaid expansion, premium tax credits, and cost-sharing assistance, many others face loss of insurance as a result of disruptions in the non-group insurance market.[ix]

With Repeal of ACA, Montana Would Have the Highest Rates of Uninsured Children and Parents in the Nation

ACA repeal could have significant negative impact on coverage of children. Currently, only six percent of Montana’s children are uninsured, but ACA repeal and proposed changes to the Children’s Health Insurance Program (CHIP) could drastically change that. In 2009, the state voted to expand eligibility for CHIP to provide coverage for more low-income children.[x] Today, over 120,000 Montana children receive coverage through Healthy Montana Kids (HMK), with approximately three-fourths of those receiving coverage through Medicaid.[xi]

[popout]If Congress repeals ACA and makes further cuts to federal CHIP funding, Montana could face an uninsured rate of 22.8% for children and 31% for parents.

These rates would be the highest in the nation.

Source: The Urban Institute, December 2016[/popout]
Under federal law, states are required to maintain the current levels of eligibility for CHIP children through 2019 (called maintenance of effort, or MOE), in order to receive federal Medicaid payments.[xii] However, ACA repeal proposals have also moved up the expiration of this provision to 2017, putting at risk whether states will maintain current eligibility levels. Furthermore, federal funding for CHIP expires on September 30, 2017. Should Congress not renew CHIP funding, states may also face budgetary pressures to eliminate separate CHIP programs.[xiii]

In each of these scenarios, Montana could face significant budgetary pressures to reduce the number of children eligible for CHIP. According to Urban Institute’s study, a repeal of ACA in combination with reductions in the state CHIP eligibility could result in 41,000 Montana kids losing health insurance, causing the uninsured rate for children to rise to 22.8%.[xiv]

Montana parents would also be at risk under repeal of ACA. Forty-two thousand parents could lose their health insurance, with nearly one in three Montana mothers and fathers going without insurance. This too would represent the highest uninsured rate among parents in the nation. Studies have shown that children’s well being is impacted by their parents’ access to health care, and the consequences of cutting parents’ insurance could be far reaching.[xv]

American Indians Would See Disproportionate Effects of Repeal

ACA repeal could also have significant impact on Americans Indians’ access to health services.  Repealing Medicaid expansion could jeopardize the improvements Montana has made improving health care access to Indian Country, and put undue strain on health care facilities. Over 8,000 American Indians enrolled in Montana’s Medicaid expansion plan and would be in danger of losing their health care coverage under repeal.[xvi]

Additionally, Congress’ intentions to repeal ACA could put at risk the provisions within the Indian Health Care Improvement Act (IHCIA), included in the ACA in 2010. Under IHCIA, federal and third-party providers are able to now reimburse Indian Health Service (IHS) for services, giving IHS and tribal services much-needed revenue and the ability to expand services.[xvii] Nationwide, reimbursements at IHS facilities, tribal operated facilities, and urban Indian clinics have increased 21% since the expansion of Medicaid.[xviii] In 2014, nearly 40% of American Indians did not have health insurance, but Medicaid expansion represented one of the most significant opportunities to expand coverage for American Indians.[xix],[xx]

Over 61,000 Low-Income Montanans Face Losing Health Coverage

The 61,000 Montanans who gained health care through Medicaid expansion are in the greatest danger of losing their health care if the ACA is repealed. By 2019, the year repeal is slated to take place, over 74,000 thousand Montanans could be newly enrolled and in danger of losing their health insurance.[xxi]

Montana Expanded Medicaid with Bipartisan Support

[popout]

Who Might Lose Health Care Coverage?

Of the 61,233 HELP plan members in danger of losing their health care coverage:

·  34,000 are women

·  52,000 are living below the poverty level

·  41,000 are people living at 50% or less of the federal poverty level

·  8,000 are American Indian

·  14,000 are between 50-64 years old

[/popout]
Dismantling Medicaid expansion overturns the desire of the State of Montana to provide access to health care for those most in need. In 2015, with bipartisan support, the Montana legislature passed the Health and Economic Livelihood Partnership (HELP) Act.[xxii] This plan allowed the state to use the federal funding available for expansion to provide health care coverage to adults with incomes of less than 138% of the federal poverty line (income of $16,384 a year for an individual, $27,821 for a family of three).[xxiii] Montana implemented Medicaid expansion using a third-party insurance company to administer the program. Montana was the first state in the country to design and implement this unique solution, using a similar model as the successful Healthy Montana Kids program.

Health and Economic Livelihood Partnership Program

The HELP Plan differs from traditional Medicaid expansion in a few ways, the most significant of which is that a third-party insurance company administers the program. Participants in the program receive health insurance services through the third-party insurance company that covers the same required services as Medicaid does.

[popout]Key Facts about the HELP Plan

·  Provides critically needed health care to low income Montanans

·  First plan of its sort in the country

·  Health care coverage through a third party administrator

·  Requires premiums and

co-payments

·  Connects participants with jobs and training programs

[/popout]

Montana’s plan also requires HELP Act participants to pay premiums of up to two percent of their income. Participants also pay co-payments, but premiums and co-payments combined cannot exceed five percent of their income. People living above the poverty line may be removed from the program. [xxiv]

The Act also created the HELP-Link program, a voluntary job services program that helps connect program participants with workforce training, employment services and job openings.[xxv] Over 6,500 Montanans have already completed the assessment.[xxvi]

Low-Income Workers Hurt by Repeal

The majority of people who would lose coverage under Medicaid expansion are employed but working at low-wage jobs that do not provide health insurance.[xxvii] Those eligible for coverage through HELP Act include food service employees, cleaning and maintenance service workers, office and administrative support, and construction workers.[xxviii] The vast majority of the people hurt by repeal are people living in poverty: 50,000 Medicaid expansion recipients live below the poverty level, with the other 10,000 living just above it.[xxix]

 

Veterans Could Lose Coverage

Veterans and their families are in danger of losing their health care coverage if the federal government withdraws funding for Medicaid expansion. Prior to the HELP Plan, Montana had the highest rate of uninsured veterans (17.3%) in the country.[xxx] Repealing Medicaid expansion could cause approximately 9,500 veterans and family members to lose eligibility for health insurance.[xxxi]  While some of these veterans have access to Veterans Affairs (VA) health care, many of them live too far away from a VA hospital or health care clinic to receive adequate care if their Medicaid coverage is taken away.

Repealing Medicaid Expansion Would Hurt Montana’s Economy

Medicaid expansion has increased the demand for health care services and supported jobs for doctors, nurses, laboratory technicians, and other medical services staff. With more people employed in the state, and with the newly insured able to spend money at the grocery store that they previously spent on health care, there is more money flowing into the economy and creating jobs. Previous studies on the impact of Medicaid expansion in Montana showed that expanding could create as many as 12,700 jobs, if permitted to continue.[xxxii]

Repealing Medicaid Expansion would cause Montana to lose hundreds of millions of dollars each year in federal funding. In 2019, the first year that repeal of ACA would take full effect, Montana would lose approximately $698 million in federal Medicaid funding. Over the next decade, Montana would lose a total of $9.8 billion in federal Medicaid funding toward health reimbursements to Montana communities and providers.[xxxiii]

The loss of Medicaid expansion funding could have a direct impact on the state’s general fund. By September 2016, just nine months after the Medicaid expansion was implemented, the HELP Act had already saved the state $10.6 million by reducing costs for the Department of Corrections ($1.3 million) and using federal funds to pay for costs that had been covered by the state ($9.3 million).[xxxiv] If ACA were to be repealed, Montana would lose the opportunity for future state savings. In fact, as the uninsured rate grows, this would likely put additional pressure on the state and local governments in additional costs of uncompensated care.[xxxv]

Uncompensated Care Costs Would Rise with Repeal

If Medicaid expansion is repealed, Montana hospitals could face significant losses. In 2013, prior to the expansion of Medicaid, Montana’s hospitals incurred $400 million in uncompensated care costs, over half of which was bad debt. People without insurance accumulated most of these costs.[xxxvi] While a full analysis on the impact of Medicaid expansion to providers may not be complete until 2017, initial surveys of Montana’s largest hospitals after the first six months of expansion have shown these hospitals have experienced a reduction in the number of uninsured patients and have seen reduced charity care and bad debt expenses.[xxxvii] Repealing expansion could result in financial trouble for hospitals that would see increases in their uncompensated care.

Montana Must Act to Protect Coverage

Montana families and the public deserve to know how a potential repeal will impact their access to affordable health insurance. With little details and the uncertainty of what replacement may be, over 142,000 Montanans are faced with the real risk of losing health coverage. Before Congress votes to repeal the ACA, there must be a clear plan in place that protects all Montanans, including those enrolled in Montana’s HELP plan. A replacement plan that provides inadequate or less affordable coverage would be devastating to the people most in need of health care.

 

Acknowledgement

The work upon which this report is based was funded, in part, through support from the Montana Healthcare Foundation. The statements and conclusions of this report are those of the Montana Budget and Policy Center.

Appendix

Table 1: Residents in Every County Could Lose Health Insurance

County HELP Plan Recipients County HELP Plan Recipients
Beaverhead 542 Madison 232
Big Horn 1,076 Meagher 192
Blaine 510 Mineral 291
Broadwater 216 Missoula 7,457
Carbon 477 Musselshell 405
Carter 53 Park 1,010
Cascade 5,085 Petroleum 20
Chouteau 243 Phillips 269
Custer 541 Pondera 545
Daniels 43 Powder River 39
Dawson 346 Powell 348
Deer Lodge 582 Prairie 32
Fallon 105 Ravalli 2,860
Fergus 599 Richland 371
Flathead 6,142 Roosevelt 1,040
Gallatin 3,988 Rosebud 564
Garfield 36 Sanders 961
Glacier 1,541 Sheridan 118
Golden Valley 85 Silver Bow 2,625
Granite 121 Stillwater 309
Hill 1,327 Sweet Grass 127
Jefferson 441 Teton 414
Judith Basin 91 Toole 218
Lake 2,397 Treasure 31
Lewis and Clark 3,427 Valley 426
Liberty 186 Wheatland 197
Lincoln 1,619 Wibaux 22
McCone 117 Yellowstone 8,174