New Report Estimates That Up to 43,000 in Montana Could Lose Health Coverage Due to Medicaid Work Requirements

A report published exclusively today on GWHealthPolicyMatters presents an analysis estimating that 26,000 to 36,000 low-income people in Montana would lose much-needed health coverage under a proposed bill to impose work requirements on Medicaid recipients. Higher premiums associated with the requirements could cause between 5,000 to 7,000 more to lose coverage, bringing the total at risk to between 31,000 and 43,000.

“Many people likely to lose coverage in Montana are already working when they can, or they live in rural areas and are unable to find work,” says the report’s lead author, Leighton Ku, PhD, MPH of the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

The analysis is part of a series of analyses by Milken Institute SPH researchers evaluating the impacts of the Medicaid work proposals that states have put forward at the invitation of the Trump administration. Milken Institute SPH researchers have also published estimates of the impacts of Medicaid work demonstrations in Arkansas and Kentucky, including an estimate of how Kentucky’s demonstration would affect community health centers.

Kentucky was the first state to propose work requirements in January 2018. A federal judge struck down Kentucky’s plan in June 2018 but the case is back in court with states like Montana waiting to find out if they can go ahead. Public health scholars recently filed a friend of the court brief asking the judge to block Kentucky’s work requirements, arguing that they are illegal and run counter to the very purpose of the Medicaid program.

Montana’s bill, called the Medicaid Reform and Integrity Act, or MeRIA, would require 18- to 59-year-old Medicaid enrollees in the state to work 80 hours per month – or lose their health coverage after three months. The draft legislation would also increase premiums for those enrolled more than two years and terminate 12-month continuous eligibility.

Montana already has a voluntary program, HELP-Link, which connects Medicaid enrollees with high-quality workforce training and employment services. “HELP-Link been successful in helping its participants find jobs and increase their wages, and it does not threaten to take away Medicaid recipients’ health insurance if they cannot find steady work,” Ku says. “The research does not show that work requirements do very much to help people find jobs, and a lot of Medicaid enrollees have been losing their insurance because of the requirements.”

Of those most likely to lose their health coverage in Montana, the report found:

  • One out of four are parents of young children.
  • One out of four have family members with a disability.
  • One out of four are in school.
  • One out of three have seasonal employment but not enough hours to meet Montana’s work requirements.
  • More than one-third live in rural areas of Montana – far from the economic hubs of the state where jobs are more plentiful.
  • One-ninth, representing more than 3,000 people, are Native Americans who could lose insurance.

People in Montana who lose insurance coverage under this bill will have reduced access to health care, which could worsen chronic health conditions and threaten their financial well-being, Ku said.

In addition, the report says hospitals, community health centers and similar medical facilities – particularly those in rural parts of the state – will lose Medicaid revenues but will also have to care for a surge of uninsured patients. That one-two punch will destabilize many medical facilities financially and increase the risk of cutbacks or even closures.

The research team’s coverage loss estimates are based on a data analysis and study. Ku and his colleage Erin Brantley, MPH, PhD(cand), a senior research associate in the Milken Institute SPH Department of Health Policy and Management, analyzed data reported by the state of Arkansas due to Medicaid work requirements. They also conducted a study of work requirements and their impact under the Supplemental Nutrition Assistance Program (SNAP) that is currently under review for publication. They used 2016 and 2017 data from the U.S. Census Bureau’s American Community Survey (ACS) based on versions published by the Minnesota Population Center.

“Potential Effects of Community Engagement Policies in Montana’s Medicaid Program” was authored by Ku and Erin Brantley, MPH, a senior research associate at the Center for Health Policy Research. The Montana Healthcare Foundation provided support for the report, which is accessible below.