MISSOULIAN EDITORIAL: HELP expand access to health care

Missoulian, September 1, 2015

Each day that passes without Medicaid expansion is another day Montana loses out.

Tens of thousands of our low-income neighbors lose out on health care. Providers lose out on federal funding that would have covered the cost of emergency room visits. Communities across Montana lose out when they are forced to pick up the extra costs of uncompensated care.

Montana’s Medicaid expansion plan, the Health and Economic Livelihood Partnership Act, is a hard-won compromise that promises to offer coverage to as many as 70,000 Montanans. The state says it is on track to launch the program within a matter of months, and could begin providing coverage as soon as Jan. 1, 2016.

But first, the plan requires federal approval – and a waiver – from the Centers for Medicare and Medicaid Services. And who knows how long that could take?

Fortunately, Montanans have one week left to offer public comment telling the feds how important this program is – and how important it is to get it up and running as soon as possible.

Last December, before the start of the most recent legislative session, the Montana Budget and Policy Center released a report pointing out that the state’s foot-dragging on Medicaid expansion was costing it “as much as $1.96 million of federal funds every day.” That figure didn’t even include the $1.38 million in lost labor productivity – or the additional $143,750 in state or local tax revenue each day. Indeed, the center estimated that Medicaid expansion would create thousands of new jobs – something nearly every legislator claimed to be working on.

Ultimately, the Montana Legislature approved the HELP Act, which will expand Medicaid but also requires that its low-income participants – those making less than 138 percent of the federal poverty level – pay a small monthly premium of about 2 percent of their income, as well as co-pays for certain services. Also, it directs the state to contract with a third party to administer benefits.

These conditions fall outside traditional Medicaid requirements and put Montana in rare company. Only a handful of other states have been granted waivers for similar provisions.

The Montana HELP Act’s special requirements are clearly its biggest challenges. They put the state in a position of needing to prove to federal authorities that its program will work as intended, despite its unique and untested methods. The unfortunate reality is that even a nominal fee may be too much for Montana’s poorest residents to bear, and the result may be that many eligible participants opt not to enroll. Also, the money collected may not be enough to cover the costs of collecting these payments.

Still, the HELP Act represents a compromise years in the making and is far better than having no Medicaid expansion program at all.

The Montana Department of Health and Human Services is collecting public comment on the HELP Act through Sept. 7 – the last chance for Montanans to have a say on the plan before the feds get a hold of it. Of course, the Centers for Medicare and Medicaid Services is required to offer a comment period as well. But the clock is ticking. The state has asked the federal agency to accept the plan by Nov. 1 and begin providing benefits by Jan. 1, 2016 – not a day too soon.

Montanans in general were supportive of Medicaid expansion efforts during the most recent legislative session. Those same Montanans – and many others – should seize the opportunity to comment now, and make it clear to the powers that be that tens of thousands of at-risk Montanans need access to health care right now.

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