HELENA — Medicaid, the state-federal program that pay medical bills for the poor and disabled, covers about 99,600 people in Montana — its highest level ever.
The economic recession has swelled the ranks of the program, which is one of the largest single expenditures in the state budget.
For the 2010-11 biennium, the Legislature budgeted $1.75 billion for Medicaid, or nearly $900 million a year. The state covers anywhere from one-fourth to one-third of the cost.
Most Medicaid spending is on aged people, including those in nursing homes, disabled people, pregnant women, children and families with dependent children. They qualify if their income is under certain levels.
Able-bodied adults without dependent kids qualify only if they are aged or have extremely low income.
Under federal health care reform, Medicaid will be expanded in 2014 to cover everyone who makes up to 133 percent of the federal poverty level. Currently, that’s about $29,000 for a family of four and $14,400 for a single person.
The Schweitzer administration is considering whether to hire a private company to “manage” part of Medicaid’s coverage.
Medicaid in Montana already has some level of managed care for many of its patients, but that care is not managed by one, large private company.
Under the Passport program, the state pays physicians a per-patient fee to manage care for many Medicaid-covered patients.
Another managed-care program for Medicaid patients was taken over this year by the state’s nonprofit community health centers and an Indian tribe, which replaced a for-profit company.
They’re running the Health Improvement Program (HIP), which covers 3,300 people and is already getting national attention, said Laurie Francis, chief executive officer of the Montana Primary Care Association.
For the same amount of money, the centers and the tribe added nurses and greatly increased the number of patients under the program, which is offering “disease management” for high-risk patients.
Francis said she’s concerned that a new managed-care demonstration project by the Schweitzer administration would displace HIP not long after it has started.
“The whole country is watching, waiting and hoping,” she said of the early buzz generated by Montana’s HIP. “It seems like we’d rather be a role model instead of switch partway through.”