The President’s Message is published in the MHA Weekly News Report, a member-only publication of the Montana Hospital Association. To subscribe, click here.

Next Thursday, October 1, is a turning point for Medicaid in Montana. The three-month “hold harmless” period for the new Medicaid Expansion community engagement requirements ends, and DPHHS will begin enforcing them.

New applicants who don’t meet the requirements will be denied coverage. Current enrollees found noncompliant at renewal face disenrollment, with the first coverage losses expected in January 2027.

The early numbers should concern all of us. In a recent presentation to the Interim Budget Committee for Section B (Health and Human Services), DPHHS reported that nearly half of enrollees reviewed during the hold-harmless period could not be verified as compliant. Past experience tells us that many people who lose coverage aren’t ineligible. They missed a letter, a deadline, or a document. According to the Department of Labor and Industry, roughly three in four Montanans on Medicaid Expansion already work or are in school. When you add in those who work as family caregivers or are disabled, that number exceeds 90%.

For our hospitals, the consequences are real: more uninsured patients, more uncompensated care, and more pressure on facilities that already operate on thin margins, especially in our rural communities.

Loss of coverage has real impacts for patients, too—for those who lose coverage, and for everyone else in a community who relies on their local hospital for care.

The Association will continue to advocate for systems and approaches that keep eligible Montanans covered. In the meantime, there are things hospitals can do. Your patient access, financial counseling, and social work teams talk with Medicaid members every day. I encourage every facility to:

• Remind patients to keep their contact information current with DPHHS and to open all mail from the department.
• Help patients identify exemptions they may qualify for, including medical frailty. DPHHS will soon post to its website a state-approved list of diagnosis codes that meet the medical frailty definition.
• Refer patients to apply.mt.gov or the Montana Public Assistance Helpline at 1-888-706-1535.

We’ll continue to monitor the rollout, share information and ways hospitals can engage. Please continue to share with us how the changes are affecting your organization, your patients and the communities you serve.