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Montana Medicaid expansion covers low-income adults ages 19 to 64, but its benefits extend to children and grandchildren.

Before Medicaid expansion, most low-income Montana adults weren’t eligible for Medicaid and the state’s uninsured rate was above 15 percent. Healthy Montana Kids covered the children, but the parents or grandparents raising them usually had no insurance.

What a difference Medicaid expansion has made in the past three years. The percentage of Montanans with no health coverage has dropped to 7 percent and preventive health care is now accessible to grandparents, parents and future parents.

For example, with regular health coverage and doctor visits, women can learn that they are diabetic or pre-diabetic before they become pregnant. That knowledge helps assure a healthier pregnancy, mom and baby, according to Dr. Rebecca Slingwine, a third-year family medicine resident at RiverStone Health, which saw nearly 15,600 unique patients in the first 11 1/2 months of 2018.

In an interview at the South Side clinic, she noted the importance of health care after child birth. Heavy bleeding during delivery may cause anemia, post-postpartum depression may not manifest for months. With regular, ongoing access to care, the new mom can get medication to help with depression.

Lifesaving care

One mom had a lump on her thyroid that was detected when she came to RiverStone late in pregnancy. After delivery, Slingwine referred the new mom to a specialist who accepts Medicaid. If she had no care, she would have died of thyroid cancer and her baby wouldn’t have a mother.

Before Medicaid expansion, RiverStone used federal grants to offer patients reduced service fees based on their income. However, there was no money to pay for needed specialty care outside the clinic.

Swingline recalled another Medicaid expansion patient who was struggling with substance abuse in pregnancy, but she got treatment, stayed clean and is now caring for her baby while going to college to earn a nursing degree.

“Because of the help she got, she got clean and the baby has a mom,” the doctor said.

RiverStone has mental health and addiction counselors on staff because mental illnesses and substance abuse issues often are seen in primary care patients.

“I have many patients who are raising grandkids or taking care of parents,” Slingwine said. Some grandparents in their early sixties are raising grandkids while working outside the home. They need Medicaid for their health care.

Dr. Chris Baumert, a RiverStone staff physician who is chief of family medicine for St. Vincent Healthcare, takes care of the community’s low-income workers.

“The majority of the Medicaid patients I have work,” Baumert told The Gazette. “One is a CNA at a nursing home who has diabetes. I have multiple truck drivers. I have patients who are restaurant workers. These are the working poor. Anybody who thinks these people are freeloaders hasn’t met them,” Baumert said.

Remember: Medicaid isn’t free to all eligible Montanans. Copayments and premiums are required of some expansion enrollees, although all of them have income below 138 percent of poverty level – less than $16,700 in 2018 for a single person.

Forty-six percent of RiverStone patients seen in 2018 were covered by Medicaid or Healthy Montana kids. In 2014, before the expansion program started, nearly half of all RiverStone patients were uninsured. In 2016, the first year of expansion, the uninsured rate plummeted to 30 percent, and it dropped to 21 percent in 2017. RiverStone and other community health care providers worked hard to get eligible Montanans enrolled.

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Covering workers

In Yellowstone County, 53.3 percent of employers have at least one worker who is covered by Medicaid expansion, according to a new Montana Department of Labor and Industry study that Gov. Steve Bullock cited on a December visit with The Gazette editorial board.

“What we’re effectively doing through a state-federal health care program is taking care of workers whose employers can’t or won’t,” Bullock said.

Purchasing employee group health insurance isn’t financially feasible for many small businesses and Montana is a state of small businesses.

About 70 percent of the 96,000 Montanans in the expansion program are working. Most of the rest are sick, injured, in intensive addiction treatment or caring for children, elders or disabled family members.

We agree that people who are able should work for their benefits. The facts show that by and large Montanans covered by Medicaid expansion are working — if they can.

We caution lawmakers who want stricter work requirements to avoid making laws that will cost more to enforce than they save. As of this year, administrative costs for the expansion program are a modest 6 percent, according to Sheila Hogan, director of the Montana Department of Health and Human Services.

Montana lawmakers also must be cautious about making compliance so difficult that low-income workers will lose coverage, as thousands reportedly have in Arkansas.

Legislators, let’s not spend more state money than necessary to administer this program that is a lifeline for low-income Montanans. Let’s make sure that state money is used to leverage federal funds to provide needed, timely care to keep Montanans working or to help them become healthy enough to work.

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