Montana DPHHS taking steps to address Medicaid redetermination call times

Montana DPHHS
Posted at 7:18 PM, Sep 13, 2023

HELENA — On Wednesday, leaders with the Montana Department of Public Health and Human Services told lawmakers that Medicaid redetermination will remain one of the biggest ongoing issues for the agency the rest of this year, and that they’re continuing to take steps to address the challenges that have come up so far.

“We're in the midst of implementing more strategies to continue to improve our customer service and ensure that Montanans eligible for Medicaid retain their Medicaid coverage,” said DPHHS Director Charlie Brereton. “That is of the utmost importance to HHS.”

Brereton spoke during a legislative interim committee meeting focused on the DPHHS budget – one of the largest shares of the state budget.

During the COVID public health emergency, the federal government said everyone on a state Medicaid program could remain enrolled without having their eligibility reconfirmed. That requirement ended on April 1, so state regulators must recheck most recipients’ eligibility annually and when they report changes like getting married or divorced or having a child. One reason someone might no longer be eligible for Medicaid is if their income rises out of the qualifying range.

In Montana, DPHHS is taking ten months to reevaluate the eligibility of about 324,000 residents who were enrolled in the Medicaid and Healthy Montana Kids programs. According to DPHHS data, 110,302 individuals went through the process in April, May and June. 55,428 of those – more than half – have had their coverage terminated.

Of those whose coverage wasn’t renewed, 16,427 were determined to be ineligible – just under 30%. 33,830 – about 61% – were removed because they failed to provide information DPHHS requested from them.

Brereton said the number of Medicaid recipients who lost coverage for procedural reasons has been trending down.

“That's really in accordance with department predictions, considering that we front-loaded the individuals and the income-based population for the first three months – those who we suspected to likely be ineligible for Medicaid,” he said.

Earlier this year, federal authorities sent DPHHS a letter, expressing concerns about the number of Montanans removed from Medicaid for technical reasons.

Brereton said Wednesday that the department was expanding public service announcement campaigns to emphasize the importance of returning the redetermination paperwork. He said they’ve temporarily suspended remote work for employees who work with clients at the Offices of Public Assistance around the state, because of the great demand for help.

“Frankly, we continue to learn more and more about this process, like all states, as we move forward,” he said. “I say this sincerely, we are committed to continuous improvement.”

The federal letter also raised concerns about the long wait times to connect with the call center helping Montanans with Medicaid renewals. It said, as of May, the average wait was 42 minutes.

Brereton said they’re taking multiple steps to shorten the wait times.

“We just welcomed yesterday another large cohort of client service coordinators,” he said. “They're undergoing training, I believe, this week and next week, and they'll quickly be on the public assistance helpline.”

He said they’re looking at expanding the call center hours beyond the standard 7 a.m. to 6 p.m., Monday through Friday. Starting this week, they’re trying a new system in which people with basic questions are redirected to less-specialized service coordinators, so they can be answered faster.

Brereton also said the state contracted to staff a separate call center to focus on people who were Medicaid-eligible specifically because of income, and that those calls had wait times of closer to two minutes. He said they are now shifting staff from that service to the regular helpline.

DPHHS leaders said, in recent months, they've been able to get a growing number of Medicaid clients re-enrolled automatically in the program because the department already has the needed information to prove they're still eligible.

Brereton says anyone who loses their Medicaid eligibility because they didn’t provide all the needed information has another 90 days to submit that information. If they do so, DPHHS will continue to treat their case as a redetermination instead of a new Medicaid application.