After a tenuous high-risk pregnancy, Maia Domitrovich gave birth to a one-month-premature baby on Sept. 7, 2023. She applied for Medicaid coverage for her son, Waylon, that same day.
Because Domitrovich is a Medicaid enrollee, Waylon should have been covered promptly, according to Medicaid rules. But the baby was not covered for nearly four months, she explained.
Domitrovich and her husband took their newborn to the doctor multiple times a week at the beginning because doctors were worried about his weight loss and he was jaundiced. She was told by doctors in November that his visits were not covered by Medicaid and she would soon have to start footing the bills if they didn't get him enrolled.
In an attempt to get Waylon’s health care sorted out, Domitrovich waited on hold for seven hours one day while home alone with her baby. Waylon overflowed his diaper and Domitrovich had to bathe him while he was screaming — all while staying on the phone waiting for a response.
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Domitrovich is one of thousands of parents in Montana who are struggling to get Medicaid coverage for their children in a timely manner. Following the federally mandated “redetermination” process, delays in applications for the health care program in Montana have steadily increased to some of the highest rates in the nation. The slow processing times have left newborns and children without health care and have pushed their pediatric providers into financial hardship.
Trimming access
Medicaid "redetermination" or "unwinding" refers to a federally required process that took place nationwide. During the public health emergency tied to COVID-19, people who might be no longer eligible for Medicaid under certain metrics were not removed from the insurance program. But once the public health emergency officially ended, the federal government ordered states to go back through their Medicaid rosters and reassess enrollees' eligibility. That resulted in huge swaths of people who were still eligible being kicked off the insurance program.
The delays appear to be related to the increase in Medicaid applications the state has been receiving as a result of unwinding, creating a backlog.
Roughly 87% of the Montana Medicaid population was reevaluated through the process, according to the director of the Department of Health and Human Services (DPHHS), Charlie Brereton. The majority of those kicked off Medicaid were removed for procedural reasons like not returning paperwork. This means they are likely still eligible and end up reapplying. For the last year or so, the state has had to process all those people in addition to the typical load of new applicants.
“The Medicaid redetermination process is a reasonable, bipartisan undertaking required by federal law to address the fact that many Montanans receiving taxpayer-funded Medicaid coverage had not been reassessed for eligibility for about three years due to the now-expired federal COVID-19 public health emergency," Brereton said in a written statement. "Through this process, DPHHS has ensured that the safety net doesn't collapse and remains available for our state's most vulnerable residents, while also protecting taxpayer-funded programs from intentional or unintentional abuse."
Federal guidelines stipulate that income-qualified applications — both for people reapplying after being kicked off and brand-new applicants — must be processed within 45 days.
Nationwide, over half of the population’s applications processed during 2023 took less than 24 hours on average. More than two-thirds of applications were processed within a week. During that same time period, only about 6% of applications exceeded the 45-day limit, according to quarterly reports from the Centers for Medicare and Medicaid Services (CMS).
Since redetermination began in April of 2023, Montana has ranked among the worst 10 states for the proportion of income-eligible applications being processed outside the 45-day window. The proportion of applications taking more than 45 days steadily increased from 11.75% in June 2023 and reached 38.49% in December, which was the fourth highest at the time. In January of this year, which is the most recent data, the proportion of noncompliant applications decreased by .15% to 38.34%, which was the fifth highest in the nation for that month.
“The application processing time is an important indicator for statewide performance,” said Jackie Semmens, policy analyst for the Montana Budget and Policy Center, a group that has been critical of the redetermination process in Montana. “It’s just an indicator that our system is not very efficient, which we can see by the huge number of people who lost coverage due to procedural reasons.”
"The volume of work created by late redeterminations, new applications, duplicative applications and change reporting has resulted in a nearly 60% increase in applications processed in December 2023 compared to July 2023," Jon Ebelt, communications director for the department of health, said in an emailed statement. "The department is committed to processing cases as quickly as possible, while at the same time ensuring they are processed accurately and protecting the integrity of our programs. Most applications are processed within federally allowable application processing timelines."
According to DPHHS, the median processing time for all income-based applications — not just those that are delayed — from the most recently reported month December 2023 was 30 days.
During legislative committee meetings this year, DPHHS, the state body responsible for redetermination and Medicaid, acknowledged the delays in processing times.
Jessie Counts, human and community services division administrator for the department, said at a meeting in mid-March that there are “certainly” cases taking “more than 45 days," adding that new applications are “averaging at around 48 days.”
"There are many reasons why a redetermination might exceed the 45 days, in large part because we are really focused right now on cases that have closed and the client has now resubmitted information,” Counts said at that same meeting. "When we’re looking at balancing our caseload, we are cognizant that to a certain degree we'll be taking a hit on what that timeliness looks like and it's an intentional decision.”
“For the most part, states are really fast with processing times,” Semmens said. "I think Montana is the real outlier."
Deadlines fly by
Hannah Williams, for example, and her two young children were delisted two weeks before she gave birth to her third child in late 2023, and they have not had coverage since. She estimates she’s looking at between $9,000 and $10,000 in unpaid care costs.
Williams first enrolled herself and her eldest son in Medicaid when she got pregnant with her second child, and when her second child was born she got on the program too.
But in October of 2023, Williams — who was pregnant with her third child at the time — and her children were removed from Medicaid just two weeks before she gave birth.
![Hannah Williams plays with her three children](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=150%2C100 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=200%2C133 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=225%2C150 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=300%2C200 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=400%2C267 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=540%2C360 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=640%2C427 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=750%2C500 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=990%2C660 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=1035%2C690 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=1200%2C800 1200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=1333%2C888 1333w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=1476%2C984 1476w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/3/bf/3bf14732-145e-11ef-984c-a38632cd73d3/6647711baa1c0.image.jpg?resize=1763%2C1175 2008w)
Hannah Williams plays with her three children in their Bozeman apartment on May 16. Her eldest son, Gary, center, is autistic and has hypoglycemia. Between all her children’s sick visits, routine appointments, vaccines and supplies for Gary’s hypoglycemia, she estimates her children have received upward of $10,000 in medical care, none of which has been covered by Medicaid.
In mid-November, Williams reapplied for health care coverage for her and her three children, and she did not hear from the department until early May, despite making multiple phone calls to state numbers. That’s over 100 days beyond the federal guidelines.
Her eldest son, Gary, is autistic and has hypoglycemia. Between all her children’s sick visits, routine appointments, vaccines and supplies for Gary’s hypoglycemia, she estimates her children tallied thousands of dollars in medical care, none of which has been covered by Medicaid. During that same time all her children contracted Influenza A and COVID-19 and her newborn got what Williams suspects was some sort of respiratory virus.
“It’s been a nightmare,” she said. “These bills have just been racking up and racking up.”
The doctor that Williams’ children see has not yet started making her pay for the charges that should be covered by Medicaid in theory.
![Hannah Williams holds her 7-month-old daughter](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=150%2C100 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=200%2C133 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=225%2C150 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=300%2C200 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=400%2C267 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=540%2C360 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=640%2C427 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=750%2C500 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=990%2C660 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=1035%2C690 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=1200%2C800 1200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=1333%2C888 1333w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=1476%2C984 1476w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/4/95/495b60d8-145e-11ef-8eb2-a36d42ffa235/6647713231500.image.jpg?resize=1763%2C1175 2008w)
Hannah Williams holds her 7-month-old daughter Dottie on May 16 in their Bozeman apartment. Williams and her children were delisted from Medicaid two weeks before she gave birth to Dottie in late 2023, and they have not had coverage since.
Nerve-wracking bills
Some pending families are seeing the costs come due.
Randi Johnson, a Belgrade mom, waited for Medicaid coverage for her two kids — now ages 3 ½ and 6 months — for so long her provider requested she enter a payment plan to foot the bills.
She called DPHHS multiple times and her local Office of Public Assistance and waited on hold for an hour and a half before her toddler accidentally hung up. Multiple people, local to her OPA office and with the state, told her about the 45-day rule and expressed that her application would likely exceed that timeframe, she said.
![The Montana Department of Health and Human Services](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=150%2C100 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=200%2C133 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=225%2C150 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=300%2C200 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=400%2C267 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=540%2C360 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=640%2C427 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=750%2C500 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=990%2C660 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=1035%2C690 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=1200%2C800 1200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=1333%2C888 1333w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=1476%2C984 1476w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/f5/1f5ce04a-c08f-11ee-ab78-57e97d3a742c/65bad5676523c.image.jpg?resize=1763%2C1175 2008w)
The Montana Department of Health and Human Services in Helena.
“It just blew my mind how … this is normal,” she said.
During the span of 90 days — Feb. 2 when she applied for her children to May 2 when they were approved — she had to make four doctor visits for her children: a sick visit for her toddler, an ear infection visit for her toddler, a routine 4-month-old well-check for her newborn and a sick visit for her newborn once he caught his brother’s sickness.
“It was really stressful,” Johnson said. “ [I was] having to have faith that everything was going to be OK.”
Like many doctors in Montana have taken to doing, Johnson’s did not charge her for those visits immediately because they understood she was waiting on coverage for her kids. She was told it would likely be back-billed to insurance when and if her children were eventually approved.
“It’s nerve-wracking when you get a bill and you're told ‘you should be able to back-pay this.’ ‘Should’ and ‘can’ and ‘will’ are very different things,” she said.
Eventually, the provider requested she foot the bills under the payment plan, because she said it would have been “hard to afford it all at once.”
At Helena Pediatric Clinic, where the Medicaid population hovers between 35 and 40%, Dr. Callie Riggin and her colleague Dr. Teresa Augustine have both taken pay cuts and have started to turn some non-critical patients away following redetermination woes.
![Dr. Teresa Augustine](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=150%2C100 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=200%2C133 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=225%2C150 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=300%2C200 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=400%2C267 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=540%2C360 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=640%2C427 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=750%2C500 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=990%2C660 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=1035%2C690 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=1200%2C800 1200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=1333%2C888 1333w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=1476%2C984 1476w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/0/19/019d574c-116b-11ef-bb2f-338267d9e5ae/66427e2824a5f.image.jpg?resize=1763%2C1175 2008w)
Dr. Teresa Augustine, a pediatrician at Helena Pediatric Clinic, poses for a portrait on May 13 inside the clinic.
In the first couple months of life, babies should visit the pediatrician multiple times for routine well-checks and eventually vaccinations. Over the last few months, both Augustine and Riggin said they see parents daily who are struggling to get their children enrolled in Medicaid in a timely manner. Some are waiting months.
“By the time the babies need vaccinations starting at 2 months — that’s 60 days — most of these newborns [are not] on board with Medicaid and it's not the parents' fault,” Augustine said, adding that she often quizzes the parents on their Medicaid application status.
When babies and kids come in sick, they are always treated at Helena Pediatric. But they’ve started to send some parents to the local Office of Public Assistance if their children don’t have coverage because the clinic is struggling to cover the costs.
“Before we would do everything and wait to be reimbursed,” Augustine explained. "We can't do that anymore, so we just tell the parents formally at 2 months that if they're not on Medicaid, from our office go directly to OPA."
At Heart and Hands Midwifery and Family Care in Kalispell, roughly 80% of the patients receive Medicaid. Following redetermination, the facility had to dip into a $150,000 line of credit to keep the clinic running. Because of delayed applications, the facility has more than $8,000 in services provided to infants who are “pending” on Medicaid and nearly $50,000 in obstetrics-related services for patients who are attempting to get covered by Medicaid, to name a few debts. Using the line of credit costs it nearly $1,000 a month in interest, according to Chief Operating Officer Kendall Brooks.
Some of that financial loss came from newborns not getting coverage in a timely manner, which Brooks called “pretty common” in recent months.
“Right now, people are just sitting powerless in a pending state,” Brooks said. The clinic is not reimbursed for many of the patients whose Medicaid status is “pending."
“It feels like an uphill battle that never will be done,” she said. “We made every business decision we could make to be able to improve our overhead without reducing our quality of care.”
'Set up to fail'
Montana has been out of compliance with the 45-day rule since before redetermination. Exactly why the state has historically had issues completing applications in a timely manner is unclear and multiple people interviewed by the Montana State News Bureau did not have a concrete explanation.
“There’s always been issues with insurances, but nothing like this,” Riggin said.
Multiple people, both inside and outside DPHHS, said the reason for historic delays is probably a combination of issues, but could be related to outdated IT systems and staffing deficits. Others pointed to budget cuts that resulted from a 2017 special legislative session, during which lawmakers dealt some of the most significant reductions to DPHHS to the tune of hundreds of millions of dollars in state and federal funds. As a part of these cuts, 19 Office of Public Assistance offices closed, which is something that is often pointed to when it comes to delays in processing times.
“Montana went in knowing we had problems and decided to rush it anyway,” Semmens said, referring to the fact that Montana elected to execute unwinding over a 10-month period, which was one of the faster tracks nationwide. States had 14 months to finish unwinding and 43 states planned to take between 12 and 14 months.
Lesa Evers, a 24-year employee who worked with Medicaid and retired late last year from the state health department, said she remembers a few Montanans calling in and saying their applications were taking longer to process than 45 days. But she added that she “never really understood that it was any kind of major problem historically.”
“If historically that’s been the case and you bring the redetermination thing in and it’s accelerated you’re kind of set up to fail in the beginning,” Evers said.
While CMS has had some public communication with Montana on redetermination issues, the body has not publicly addressed processing delays in Montana or elsewhere, said Tricia Brooks, a research professor at Georgetown University’s Center for Children and Families.
“Things are not exceedingly well in Montana, but then again I think they’re a challenge in all states,” she said. “It’s an unusual time. It’s an unusual event.”
DPHHS did not address the historic delays, but did say that the state "has not received notifications from CMS regarding lack of compliance with Medicaid application processing timelines."
There is some indication that processing times are top of mind for CMS. Earlier this month, CMS released a letter and a presentation reminding states that the feds “expect” applications to be processed within federal guidelines and offered strategies as to how to better execute those processes.
"It’s also important context that when an individual applies for Medicaid, the department is required to verify a significant amount of information related to the case. Individuals who do not submit verifications with their applications are often required to submit the documentation before the case can be processed," Ebelt said in an email.
DPHHS director Brereton also acknowledged the delays at a May 9 interim legislative committee meeting.
![Charlie Brereton](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=150%2C107 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=200%2C143 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=225%2C161 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=300%2C214 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=400%2C286 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=540%2C386 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=640%2C457 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=750%2C536 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=990%2C707 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=1035%2C739 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=1200%2C857 1200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=1333%2C952 1333w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=1476%2C1054 1476w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/c/1b/c1b8a6e2-c078-11ee-bf4c-37d125ac7983/65baafe15cda0.image.jpg?resize=1703%2C1216 2008w)
Charlie Brereton, the director of the Montana Department of Public Health and Human Services, is pictured at right, next to Gov. Greg Gianforte, in January 2024.
According to data provided to a legislative interim committee in March, there are tens of thousands of people whose cases are still pending: 15,079 kids and 29,436 adults.
While other populations — such as adults — saw larger proportions disenrolled from Medicaid, children, by virtue of their age, have a higher eligibility threshold than other groups. As of early March, around when redeterminations ended, nearly 36,000 children have been kicked off Medicaid.
The federal government sent a letter in December addressed to Gov. Greg Gianforte because Montana had the fourth-largest percentage drop nationwide — 18% as of the fall — in the number of children who lost coverage since the unwinding process began. Federal Secretary of Health and Human Services Xavier Becerra wrote he was “deeply alarmed” and urged the state to take measures to correct its course.
“Children are more likely than their parents to qualify for Medicaid due to higher income eligibility thresholds for children in Medicaid and CHIP,” Becerra wrote. "This means that as children go through the renewals process, many children should still be Medicaid- or CHIP-eligible and should not be getting disenrolled. Many states have already taken steps to ensure eligible children stay enrolled.”
The methods DPHHS used to execute unwinding remain unclear, as the department has declined interviews with staff and the agency has not publicly addressed legislators’ questions. But the state has continually said that before the process kicked off, the federal government approved the state’s redetermination plan. Brereton, the director, also said that his department plans to release a report on redetermination in June.
“I don't know how it's being tolerated by the citizens of Montana,” Augustine said.
Domitrovich's son, Waylon, is healthy despite being a month premature. He has maintained his health care coverage since finally getting enrolled in late November. Both of Johnson’s boys are insured now as well.
But Williams and her children are still uncovered. After over 160 days of waiting DPHHS told her they needed her to fill out another form to move forward with her application for her children. She plans to submit that form in short order as the days of living without coverage rack up.
![Hannah Williams and her children are still uncovered as of May 16.](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=150%2C100 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=200%2C133 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=225%2C150 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=300%2C200 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=400%2C267 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=540%2C360 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=640%2C427 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=750%2C500 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=990%2C660 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=1035%2C690 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=1200%2C800 1200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=1333%2C888 1333w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=1476%2C984 1476w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/5/31/53172a8e-145f-11ef-b6fb-636b8bf6c3e3/6647733e21e77.image.jpg?resize=1763%2C1175 2008w)
Hannah Williams and her children are still uncovered as of May 16. After over 160 days of waiting, the state health department told her they needed her to fill out another form to move forward with her application for her children. She plans to submit that form in short order as the days of living without coverage rack up.
![Montana State News Bureau](https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=150%2C136&order=crop%2Cresize 150w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=200%2C182&order=crop%2Cresize 200w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=225%2C204&order=crop%2Cresize 225w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=300%2C273&order=crop%2Cresize 300w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=400%2C364&order=crop%2Cresize 400w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=540%2C491&order=crop%2Cresize 540w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=640%2C582&order=crop%2Cresize 640w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=750%2C682&order=crop%2Cresize 750w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=990%2C900&order=crop%2Cresize 990w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=1035%2C941&order=crop%2Cresize 1035w, https://bloximages.chicago2.vip.townnews.com/helenair.com/content/tncms/assets/v3/editorial/1/7b/17b5e048-9a16-11ee-8fb1-03e57c8f5296/657a498b714d0.image.jpg?crop=1174%2C1067%2C377%2C0&resize=1174%2C1067&order=crop%2Cresize 1200w)