House committee to take action Wednesday on Medicaid, CHIP revision bill

Daily Montanan

Here’s what happened when one little girl with debilitating arthritis was kicked off CHIP, the Children’s Health Insurance Plan, for three months.

Her mom is a massage therapist who works seasonally, like many Montanans, said Lauren Wilson, vice president for the Montana chapter of the American Academy of Pediatrics. The mom was asked to verify her eligibility, and for one month out of 12, she made too much money to qualify, but during the whole year, she was eligible.

In the meantime, the little girl no longer had affordable access to medicine that cost $6,000 a month. Her arthritis got so bad, she couldn’t go to school, and she had to repeat a grade.

“Her mom literally had to carry her to the toilet and back,” Wilson said.

She ended up on medicine that was even more expensive because her body had made antibodies against the one she had taken before, Wilson said: “I think that there’s lasting damage from this, both to her joints and to her going through this experience.”

In a hearing Tuesday on House Bill 676, Wilson noted the little girl is among 19 percent of children who have chronic health conditions, such as epilepsy and asthma. She asked legislators to oppose the bill, and she was among numerous opponents who said the changes will harm children and vulnerable communities such as Native Americans.

“These are not just numbers,” Wilson said.

Wednesday, the House Human Services Committee is expected to take executive action on the bill.

In her introduction to the legislation, sponsor Rep. Jane Gillette, R-Bozeman, argued the changes would ensure people were enrolled in the correct program, and they also would protect the ability of DPHHS to provide services in times of budget shortfalls.

“When we receive millions and millions of dollars, and we conserve our funds, we can spend those dollars on things we really want to invest in,” Gillette said, naming mental health care and foster care as a couple of examples.

The bill had support from Gov. Greg Gianforte’s office and the Montana Department of Public Health and Human Services. At the hearing, Erica Johnston of the state health agency said the changes would help the department serve more people.

“As we look to constrictions in our budget moving through House Bill 2, this bill allows us to utilize anticipated net savings to the general fund and deploy them to populations most in need of the services of the department,” Johnston said.

In addition to representatives from the Governor’s Office and DPHHS, the other two people who testified in favor of the bill were Rep. Matt Regier, R-Kalispell, who called for a clean and efficient administrative program, and Rep. Terry Moore, R-Billings. Moore said children insured under CHIP now would be insured privately if their family’s plan covers at least 80 percent of a premium.

“I find the bill to be sensible and reasonable,” Moore said.

Opponents didn’t quibble with the goal that the Department of Public Health and Human Services should be able to run efficient programs. But they voiced many objections to how the bill would end up playing out in real life for children, single parents, Native Americans living in urban areas, and others. And at least one opponent noted the bill would hurt Montana’s economy.

Kelsen Young, with the Montana Coalition Against Domestic and Sexual Violence, said she was concerned the bill was being heard so late into the legislative session, especially because it undoes progress lawmakers have made for children in the past. (Cora Neumann, founder of We are Montana and public health practitioner, noted even before the pandemic, one in six Montana children lived in poverty, and 40 percent of Native children lived in poverty; and SJ Howell, of Montana Women Vote, noted the state’s rate of uninsured children has been going up, rising 25 percent from 2016 to 2019.)

“Honestly, Mr. Chairman, I think it must be the late time of the day, but I’m surprised a lot of people aren’t more angry,” Young said. “It’s a significant change. It is undermining a lot of things that we have tried to do in Montana to take care of our young people. And it’s quite concerning that it’s happening this late in the game.”

Patrick Yawakie, representing the Blackfeet Tribe, said the bill would affect tribal members living in urban areas, and he urged the committee to oppose the legislation to avoid litigation. He also said tribes were not properly consulted.

“There has been no proper dialogue with Montana tribal nations regarding this matter, which has major implications on these tribal members living off reservation,” Yawakie said.

John Doran, with Blue Cross and Blue Shield of Montana, said the bill would hurt children and Montana’s economy. A recent report found Medicaid expansion pays for itself, he said, injecting $650 million into the economy and supporting 6,000 new jobs and $400 million in personal income.

“When about 25 percent of all Montanans are on the Medicaid expansion program and 25 percent of businesses have an employee who is on that (program), this bill will impact the economy of Montana,” Doran said.

Since 1999, Blue Cross and Blue Shield has been the third party administrator for Healthy Montana Kids, the state’s CHIP program, Doran said. And the state’s largest insurer has the responsibility to make sure the health of Montana’s children and adults is being upheld, and he said the bill ran contrary to that goal.

“This bill will in fact kick kids off of Healthy Montana Kids,” Doran said.

For example, if a single mom with two children is working a minimum wage job for an employer that offers coverage, her children aren’t eligible for CHIP anymore. But he said that employer’s health care may still be unaffordable for that family.

Plus, he said removing the 12-month continuous enrollment provision means Montana will regress to the days people had to reapply for coverage on a monthly basis:

“One month they have health insurance coverage, one month they don’t have health insurance coverage,” he said.

The result? They don’t see the doctor when they need care, he said.

The pandemic put many people out of work and put a microscope to the importance of the health of a population, Doran said: “Now is not the time to be kicking adults off of coverage. Now is certainly not the time — never is the right time — to be kicking children off of coverage.”

Several people from the Rocky Boy’s Reservation also testified the bill would hurt Native Americans, who already face inequities in health care compared to other populations. They argued the bill would add to disparity in health care services. 

Loni Taylor, a councilwoman for the Chippewa Cree Tribe, said Native Americans have inadequate access to comprehensive health services, in part due to the “gross underfunding” of Indian Health Services. As a comparison point, she said the federal government spent $8,602 for federal inmates per capita, and it spent $2,843 for patients in IHS.

Tessie LaMere, of the Chippewa Creek Tribe and Rocky Boy Health Center, said Medicaid expansion has meant shorter waiting lists for patients. She said patients who weren’t deemed a medical priority in the past used to wait months, even years to see specialists. 

“This has increased our capacity to help our patients in our service area, and we no longer have to prioritize one person’s illness over another person’s,” LaMere said.

Rather, they have been able to detect cancer early in patients, improve heart conditions, and prolong people’s lives. LaMere said regulations and extra paperwork shouldn’t prevent people from getting health care, but HB676 makes access to coverage more difficult for both children and adults, and it does so during a devastating pandemic.

Keaton Sunchild, of Western Native Voice, said the bill will only add another barrier to a group of people who have struggled with barriers “in every corner of their lives.” He said the bill will lead to the loss of life, especially on reservations.

“We’ve spent a lot of time this session talking about the value of life. If a majority of you truly are pro life, you won’t vote for this bill,” Sunchild said.

Heather O’Loughlin, of the Montana Budget and Policy Center, said the bill would require people to come up with paperwork that verifies an “absence of income,” and it also would mean people will have to dig up documents related to their most recent coverage. But some people have never been insured, and others might have been insured so long ago they don’t remember details or have documents.

“The level of rigidity that this has could have significant unintended consequences,” O’Loughlin said.

Duane Preshinger, of the Montana Hospitals Association, also opposed the bill. He said people should be enrolled in a timely and accurate way for Medicaid and CHIP.

“We believe this bill goes too far in regards to that,” Preshinger said.

In her closing comments, Rep. Gillette pushed back on the argument that children would lose coverage. She also said it was no surprise that Blue Cross and Blue Shield and the Montana Hospitals Association were testifying against the bill; she said the insurance provider had a conflict of interest, and the hospitals took in money from Medicaid.

“Anything that moves a child away from CHIP and onto employer-sponsored health care decreases their own revenue,” Gillette said of Blue Cross.

She said hospitals will get $300 million in 2023 from Medicaid expansion, and she noted the HELP Act pays $9,000 per enrollee, of which $3,000 goes straight to hospitals.

“So it’s no wonder that they have come in as opponents,” Gillette said.

She also reminded the committee that she leads a nonprofit that serves people who are on Medicaid, some 95 percent, including those who are a homeless and disabled.

“I would literally never ever do anything to harm or hurt that population, and I hope you know that I am sincere in that,” Gillette said.