Financial Struggles Amid Medicaid Unwinding
As Medicaid redeterminations unfold in Montana, a wave of payment disruptions is leaving healthcare providers and patients struggling financially. Jason George, manager of three assisted living facilities, faces a mountain of unpaid Medicaid claims, amounting to 0,000, leaving him short on funds to pay his staff.
Overburdened State Processing Creates Delays
State health officials acknowledge the surge in Medicaid cases but maintain that they’ve worked to address backlogs. However, providers report long delays in processing applications, re-enrollments, and inconsistent payments for eligible recipients.
Unpaid Care Drains Resources
The financial strain is especially dire for small providers who rely heavily on Medicaid revenue. One Health, which operates clinics in rural eastern Montana and Wyoming, anticipates a .5 million deficit this year due to unpaid claims. Yellowstone County Health Department faces a .2 million shortfall.
Communication Breakdown Exacerbates Problems
Patients and providers face extended wait times on phone lines and limited in-person support, making it difficult to resolve issues or access timely assistance.
Providers Take Desperate Measures
To stay afloat, some providers have resorted to taking on high-interest loans to cover expenses. Caslen Living Centers, which operates six assisted living facilities, has unpaid Medicaid claims of around ,000.
Inconsistent Information and Errors Hinder Patients
Stan Klaumann’s mother, a resident of one of Guardian’s assisted living homes, experienced four months without Medicaid payments due to unexplained errors and incomplete information. This left Klaumann navigating a maze of phone calls and trips to government offices, encountering conflicting explanations.
Varied Approach to Unwinding
Montana’s approach to unwinding Medicaid stands in contrast to other states that have paused procedural disenrollments or expanded outreach efforts. This difference may have contributed to Montana’s higher procedural disenrollment rate.
Substance Use Treatment Programs Hit Hard
Crosswinds Recovery, a substance use disorder program in Missoula, faces ongoing financial challenges as some clients lose Medicaid coverage unknowingly. The program lacks dedicated billing staff and struggles to recoup payments for services rendered.
Providers Seek Alternatives to Keep Care Affordable
Faced with the uncertainty, providers are exploring grant proposals and other funding sources to continue providing care to those in need, regardless of their ability to pay.
Conclusion
The Medicaid payment disruptions in Montana highlight the challenges that arise when a critical safety net is redetermined. The financial burden on healthcare providers, the delays in processing applications and claims, and the breakdowns in communication create a system that fails to provide timely and equitable care to those who need it most.
