LIVINGSTON — In the windswept Yellowstone River town of Livingston, there's just one hospital to serve the county that stretches from Cooke City to the Crazy Mountains. Among Park County's 17,000 residents, 1,500 (9.5 percent) are covered by Montana Medicaid expansion. Besides providing access to quality, affordable health care for those 1,500 adults, the program has benefited the entire community.

"It's really helped those who are working," said Deb Anczak, Livingston Healthcare chief executive officer. "Fifty-eight percent of Park County businesses have (Medicaid expansion) enrolled employees." Statewide, more than half of all businesses have at least one employee who has been covered by the program, according to a Montana Department of Labor and Industry report.

"What it allows people to do is seek care at the appropriate time," Anczak told The Gazette on a recent visit to Livingston Healthcare, an affiliate of Billings Clinic. For Park County, Anczak said, Medicaid expansion resulted in:

  • More people getting preventive health care, such as mammograms and other cancer screenings.
  • The hospital and clinic adding jobs.
  • Hiring a psychiatrist and mental health nurse.
  • A clinic staff member training to become an addiction treatment counselor.
  • A 10-percentage point reduction in the proportion of uninsured patients. The uninsured used to be 16 percent of patients, now the uninsured are only about 6 percent.
  • A 20-percent reduction in uncompensated care.

"We're able to take that and reinvest in health care," Anczak said. Thanks to the reduction in bad debt and charity care because of Medicaid expansion, the entire community has local access to outpatient psychiatric care that is integrated with primary care.

When Medicaid expansion became available, Livingston Healthcare staff worked hard to get eligible Montanans enrolled. Many Park County residents have multiple jobs and seasonal employment connected to tourism and outdoor recreation — jobs that often don't offer year-round health coverage.

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"We educate new patients about options for coverage," Anczak said.

Medicare remains the biggest payer for Livingston Healthcare at 46.33 percent of revenue, followed by Medicaid at 17.6 percent (including traditional and expansion programs) and about 4 percent self-pay. The remainder is private insurance.

One hundred thirteen babies were born at Livingston Healthcare in 2018, including 52 covered by Medicaid. Before Montana Medicaid expansion in 2016, few of those infants' mothers would have qualified for coverage until they were pregnant and their coverage would have ceased just a few weeks after delivery. With Medicaid expansion making all very low income Montanans eligible for coverage, most of those 52 moms were eligible for Medicaid coverage to keep them healthy before, during and after the pregnancy.

That's just one of many ways continuous coverage helps Montana families. Communities large and small across our great state have stories like Livingston: Medicaid expansion has covered workers who didn't previously have insurance, it covers otherwise uninsured parents, it boosts access to treatment for addiction and mental illnesses.

Despite the overwhelming evidence of the program's success in Montana, its future beyond June 30 is uncertain. The House last week approved HB658, a Republican plan to continue Medicaid expansion — with the addition of administrative costs and complexities for enrollees. Despite its shortcomings, HB658 must pass. It is the only path left for keeping most of 96,000 Montanans covered.

The bill now is in the Senate. Please encourage your senator to support HB658 to continue Medicaid expansion. Messages may be left by phoning 406-444-4800 or by going to leg.mt.gov and clicking on the bar that says "message a legislator."

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