By Corin
Cates-Carney, Montana Public Radio November 7, 2019
People
on Medicaid who work rural seasonal jobs in Montana are wondering about the
future of their access to health coverage. Montana recently passed a law that,
if it gains federal approval and goes into effect as planned in January, would
require many Medicaid recipients to prove they work a set number of hours each
month.
Kate
Clyatt is one of those seasonal workers. She’s 28 and works as a ranch hand in
the unincorporated community of Helmville, Mont., where there’s a saloon, rodeo
grounds, two churches, a K-8 public school and a post office. In the sweeping
ranchland surrounded by mountains, there are also a lot of cows.
On a
typical morning, Clyatt is moving cattle — coiling up an electric fence on a
spool and whistling to encourage the herd to move along.
She
wears a snap-collared flannel shirt tucked into bluejeans, and a sweat-stained
cap that keeps the sun from her eyes. She also wears a brace on her right wrist
— support for an injury she got when she rolled a four-wheeler a couple weeks
earlier.
Clyatt
explains that she stayed on her parents’ health care plan until she was 26, as
allowed by the Affordable Care Act. Then, when she aged out, she signed up for
Montana’s expanded Medicaid program.
“Ranching
is just not a job with a lot of money in it,” Clyatt said. “I don’t know at
what point I’m going to be able to get off of Medicaid.” To qualify for Montana
Medicaid, a program jointly funded by the state and the federal government,
individual adults must make no more than around $17,000 dollars a year.
Herding
cattle is a hard way to make a living, Clyatt says. But, like a lot of
Montanans, she loves working outside.
“There’s
a lot of seasonal work in our parks,” Clyatt said, “in our forest systems,
guiding — bringing income into this state. I mean, there is just a lot of
seasonality to a lot of the quintessentially Montana jobs.” Such work and
income may ebb and flow, but the need for medical coverage doesn’t.
Clyatt
doesn’t keep track of her work hours; she gets paid by the month. And she’s
unclear how that might fit into Montana’s new law that says certain Medicaid
enrollees need to prove they work or do other “community engagement activities”
for at least 80 hours a month to receive care.
Those
required “community engagement activities” can also include vocational
education, substance use disorder treatment and community service, among other
options.
A part
of Montana’s new law does attempt to carve out exemptions for workers in
seasonal jobs, but the state health department is still developing what that
will look like.
Those
who don’t meet the exemptions will have to report their compliance with the requirements.
For rural workers like Clyatt, that constant reporting could be difficult — she
only gets cell service at the stop sign on the edge of town.
When
work and reporting requirements went into place in Arkansas last year, 18,000
people lost health coverage. Arkansas, Kentucky and New Hampshire all
have seen their “work requirement laws” blocked this year, as a federal judge
raised questions about what the policy could mean in terms of a potential loss
of health care coverage.
Backers
of the work requirements in Montana say a legal fight may also challenge the
policy, which narrowly passed in the state’s 2019 legislative session. But
until that happens, or the Supreme Court takes up one of the other state’s
cases, Montana will keep rolling out its plan.
Heather
O’Loughlin, with the Montana Budget and Policy Center, an
organization that advocates for social services for people who have low
incomes, says health coverage losses like those experienced in Arkansas are
expected in Montana too.
“There
are going to be a number of enrollees that will be subject to these
requirements,” O’Loughlin said. “And what we’ve seen in other states — Arkansas
in particular — is that the vast majority of those that are subject to the
requirements … often have challenges in reporting their hours.”
After
Montana state health department officials watched around 17,000 people in New
Hampshire fail to comply with that state’s policy, Montana increased its
estimate of how many residents it expects its own new law to impact.
State
officials now project 4-12% of current Medicaid enrollees will be affected:
They will either fail to meet the work requirements in the law, or won’t comply
with the monthly reporting process regarding their work hours and status. That
means up to 12,000 people could lose health coverage in Montana. (Like most
adults on Medicaid across the U.S., the majority of enrollees in Montana are
already working.)
The
work-requirements policy passed the Montana legislature with unanimous support
from Democrats and in May was signed by Gov. Steve
Bullock — also a Democrat, who is now running for president on
his track record of political wins in a state that leans conservative.
The
policy was a political compromise. Medicaid expansion in
Montana was due to expire this summer, and Republicans refused to renew it
without a work requirement. Even now, conservative leaders in the statehouse
say the bill that passed didn’t go far enough and the work requirements are
weak.
But
Republican state Rep. Ed Buttrey, who helped push the “work requirements” bill
into law, disagrees. He expects some people will lose health coverage, but said
the requirements are not meant to be punitive.
“We
never set a number of people to try to purposely disenroll,” Buttrey said. “We
wanted to find out how many people are truly able-bodied and not working — who
should be doing more to benefit themselves and their family, but weren’t.”
The
Trump administration, which encourages states to add work requirements to
Medicaid, claims such policies could improve health outcomes and get people out
of poverty.
Montana
submitted its workforce requirement proposal to the federal government at the
end of August. According to the program’s timeline, the requirements would
start in January 2020, if approved by the Trump administration.
This
story is part of a partnership that includes Montana Public Radio, NPR
and Kaiser Health News.
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