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For more than a year, Montana’s state health department has been embroiled in a sweeping effort to “unwind” the state Medicaid program, conducting a mass eligibility review of every person enrolled in the public health program, which provides health coverage for many lower-income residents.
The unwinding, being conducted after federal officials lifted pandemic-era restrictions on striking people from the Medicaid rolls last year, has seen the state remove more than 135,000 Montanans from the program. Department data indicates that most of those removals, nearly two-thirds, have been because prior enrollees didn’t provide information the department had requested for verifying their eligibility status, rather than because a complete review had deemed them ineligible.
As the unwinding process concludes, Department of Public Health and Human Services officials plan to release a full report on the impacts of the redetermination process by the end of the month. They also spoke Thursday with a committee of lawmakers who oversee the agency’s budget, giving the public an initial glimpse of what the state Medicaid system looks like now that the redetermination process is mostly complete.
State health officials said that Montana’s overall Medicaid enrollment had dropped to below pre-pandemic levels and slightly below the department’s projected enrollment for when the redetermination period ended. That applies to both the traditional Medicaid population — including children, older people and those with disabilities — and people covered by Montana’s Medicaid expansion — single adults who are eligible for the program because of their lower monthly income.
Legislative budget staffers separately calculated on Thursday that the decline in Medicaid enrollment was projected to create a $202 million budget surplus, though mostly for federal funds. Analysts estimate that $40 million of the savings would come from the portion of the Medicaid budget paid for with state dollars.
Health officials said that roughly 9% of enrollment cases, representing nearly 20,000 people, are still pending, mostly involving people with particularly complex medical or financial circumstances. Beyond that, the department indicated it is returning to its normal application processing and case review, where officials reassess Medicaid eligibility when an enrollee reports a change in their circumstances, such as the number of people in their household or their income.
But pinpointing the true “end” of the Medicaid redetermination era is not as simple as health department officials might like. The agency isn’t tracking the health insurance status of the 135,000-plus people no longer covered by the state. Some of those people may have found coverage through the federal health insurance marketplace or their employer, while others may simply be uninsured. It’s also unclear how many of the former enrollees will end up successfully reapplying for Medicaid coverage at a future date.
Lawmaker reactions to the department’s Thursday update were split by party affiliation. Democrats, who have repeatedly used the Medicaid unwinding as a political cudgel against the administration of Gov. Greg Gianforte, questioned Director Charlie Brereton about the department’s next steps in trying to reach back out to the people who lost coverage because of communication lapses.
“We have a fair number of folks who just sort of disappeared off the map here,” said Sen. Chris Pope, D-Bozeman. “There’s probably some folks that were on the rolls that still would like to be on the rolls and would still qualify … Do we just close the book on this?”
Brereton, in short, said yes — the department is not planning to continue any public messaging or outreach campaigns related to redetermination. Anyone who thinks they’re eligible for Medicaid, he added, is welcome to apply.
Sen. Carl Glimm, R-Kila, said he’s more optimistic that many of the people who didn’t respond to the department’s redetermination inquiries had simply found health coverage elsewhere.
“I would point out that, almost anywhere you go in the state, there is ‘help wanted’ signs everywhere,” Glimm said. “I think it’s fully realistic to think that a lot of these people came off the rolls because they are ineligible. And they knew they were ineligible, so they didn’t reapply. And that’s a success.”
“I would subscribe to that view. It’d be a lot easier to do so if there was data,” Pope replied. “I think that’s a decent sort of representation of what could be happening out there in the world, but we really don’t know.”
—Mara Silvers, Reporter
Welcome Wagon 👋
We’re continuing to celebrate new arrivals in our newsroom this week, this time welcoming Jacob Olness as a data reporter and digital product producer.
Jacob’s role at MTFP will focus on helping us expand our efforts to push the envelope with digital public service journalism, building on existing projects like our summer wildfire report, state Capitol Tracker and online election guides. Readers should also expect to see his byline pop up on data visualization and database reporting projects.
That sort of data-enhanced journalism is a key part of MTFP’s commitment to covering the big, complex state of Montana in ways that our readers can’t find anywhere else — and I’m deeply excited by the possibilities we’re going to be able to unlock with a second data-focused role on our team after me.
Jacob, who was born and raised in Billings, comes to us after a stint in the tech industry. He and his wife live in Billings with their two young sons.
If you’d like to welcome Jacob aboard — or point him to datasets worth exploring — reach out at jolness@montanafreepress.org.
—Eric Dietrich, Deputy Editor
Closeup 📷
The siphons failed on June 17, causing localized flooding and jeopardizing water supplies across north-central Montana’s Hi-Line region. The canal feeds water into the Milk River Irrigation Project, which provides irrigation to more than 120,000 acres of land.
Personnel from the U.S. Bureau of Reclamation, which is responsible for maintaining the siphons, have since closed the diversion gates from the St. Mary River, causing the siphons to drain. BOR officials told MTFP that the failure was caused by the age of the nearly 110-year-old infrastructure.
READ MORE: ‘Catastrophic’ failure of St. Mary siphons leads to localized flooding in Babb.
AND MORE: Blackfeet Tribe and Reclamation Bureau to share response at St. Mary Canal failure.
By the Numbers 🔢
Aggregate personal income growth experienced by Montana in non-inflation-adjusted terms between 2019 and 2024, according to a report by the nonpartisan Legislative Fiscal Division. Fiscal analysts report that the inflation-adjusted figure, which accounts for the rapid increases in the costs of goods and services in recent years, is 24.1%.
State analysts keep a close eye on those numbers, which are tabulated by federal statistical agencies because income taxes provide state government with the lion’s share of its revenue. As the analysts note, strong income growth in recent years has kept state bank accounts flush even as Gov. Greg Gianforte and the Republican-controlled Legislature have cut income tax rates.
The analysts say state revenues, including both income taxes and other sources, grew by 48% between 2019 and 2024 — or by 21% adjusted for inflation. They say that’s partly because the state’s full coffers are earning substantial interest as the Federal Reserve keeps interest rates high in an effort to tamp down inflation, as well as because many newer residents moving into Montana are coming with substantial capital gains income, which is taxed by the state but isn’t necessarily included in federal personal income statistics.
—Eric Dietrich, Deputy Editor
Downstream effects 🌊
A pair of Canadian environmental organizations have asked Canadian regulators to consider several issues that could throw a wrench in a major coal mine sale north of the Montana border. The request tees up a decision that will have implications for Lake Koocanusa, a boundary-spanning waterway that a coal mining operation in British Columbia has polluted for decades.
Wildsight and Ecojustice submitted the petition Monday out of concern that the pending sale of Teck’s coal mining operation to Swiss commodities giant Glencore bodes poorly for the prospect of adequate remediation of the land and water that have changed dramatically as a result of more than a century of coal mining in the Elk River Valley.
Wildsight Conservation Director Casey Brennan told MTFP he hopes the petition will shine a light into the “black box” surrounding Glencore’s $9 billion bid for Teck’s coal mines. More specifically, he said he hopes the petition will force Canadian agencies involved in commercial and environmental matters to consider the sale’s repercussions for taxpayers, the environment and communities living in the Kootenay watershed.
“We’re very concerned that the provincial government, and now federal government, are sleepwalking their way into a massive liability for the taxpayers of Canada,” Brennan said.
The petition puts eight questions to Canada’s commissioner of the Environment and Sustainable Development surrounding Glencore’s financial and environmental legacy, the adequacy of the bonds that the British Columbia provincial government is holding to reclaim the mines, and the sale’s implications for taxpayers.
The British Columbia government is currently holding a $1.4 billion security to reclaim the mines once they’re shuttered and has pledged to increase that amount to $1.9 billion.
Earlier this year, Wildsight commissioned a study finding that it would take $6.4 billion to remove the mining-related selenium pollution in the Elk River Valley. Selenium is a chemical element that can cause deformities and reproductive failure in fish.
Last November, the week after Glencore announced its plans to buy Teck’s mining operation, the U.S. Geological Survey published a report finding that selenium and nitrate loading in nearby waterways as a result of coal mining in British Columbia is without measured precedent.
Teck has said it will have invested nearly $2 billion by the end of this year in an effort to “stabilize and reverse” selenium and nitrate trends and “protect the ongoing health of the watershed.”
Canadian regulators have not yet signed off on the mines’ sale.
—Amanda Eggert, Reporter
Highlights 🔆
In other news this week —
On Our Radar
Amanda — U.S. Surgeon General Vivek Murthy spoke with NPR this week about his call for putting a warning label on social media platforms to encourage young users and their parents to think more carefully about social media’s impact on mental health. According to that story, teenagers now spend a mind-boggling average of 5 hours per day on social media.
Jacob — The James Webb Space Telescope has allowed astronomers to peer into the birth of three of the earliest-known galaxies, according to a Live Science summary of an article published by the journal “Science.” Scientists say the observation helps us understand how some of the universe’s first stars emerged from a primordial cloud of hydrogen.
Alex — I’m at a journalism conference in California this week and had the great luck to catch a discussion between reporters Raquel Rutledge (of the Milwaukee Journal Sentinel) and Ken Armstrong (of ProPublica) about the process behind their harrowing co-written narrative of the tragedy surrounding a 2013 home fire in Wisconsin.
JoVonne — Despite the snowy weather parts of Montana saw earlier this week, Glacier National Park’s famous Going-to-the-Sun Road is open for bikers. According to the GNP Facebook page, bikers and hikers can travel to Logan Pass but the alpine section remains closed to vehicles.
Matt — David Erickson at the Missoulian looked at a small but impactful change to public records after the city ceased a longstanding practice of posting emails to