HELENA – While the debate rages over whether Montana should expand Medicaid to cover low-income adults, a dramatic expansion of Medicaid and a related government health plan has already happened – to cover children.
It’s called Healthy Montana Kids, the program enacted in 2009 after Montana voters overwhelmingly passed Initiative 155, billed as an expansion of the Children’s Health Insurance Plan.
Supporters of the CHIP expansion said it would cover an additional 30,000 children in Montana.
It has met that goal, and more: Through April 30, the latest month for which figures are available, Healthy Montana Kids is covering 107,500 kids, an increase of 37,500 since the program officially launched Oct. 1, 2009.
“I think it’s been an outstanding success,” says Mary Dalton, manager of the Medicaid & Health Services Branch for the state Department of Public Health and Human Services. “During my career, it’s probably the most universally popular program that I’ve ever been associated with.”
Yet while I-155 was promoted primarily for its expansion of CHIP eligibility, it also expanded the eligibility for children who could be covered by Medicaid, another state-federal program that provides medical coverage for the needy.
As it turns out, the vast majority of the additional kids covered by Healthy Montana Kids since 2009 – about 33,000, or 88 percent – are on Medicaid, which has the lower income threshold.
Kids qualify for Medicaid if their family’s annual income is up to 143 percent of the federal poverty level, or $28,300 for a family of three. They qualify for CHIP if their household income is above 143 percent and up to 266 percent of federal poverty, or $52,600 for a family of three.
Children covered by Medicaid and CHIP both get comprehensive health and dental coverage, funded almost entirely by the government. The only difference is that CHIP clients have a small co-payment for some of their care.
The federal government also pays a smaller share of Medicaid costs, currently covering 66 percent, while it covers about 76 percent of CHIP costs in Montana.
About $360 million has been spent on the program in Montana since it began in October 2009, growing from $47 million in its first year to almost $96 million in fiscal 2014, which ended June 30. Over that five-year span, the federal government has covered $276 million of the costs, or almost 77 percent.
Sen. Dave Lewis, R-Helena, one of several legislators who questioned the need for the CHIP expansion in 2009, says the huge Medicaid numbers appear to bear out what he said: Not that many families really needed CHIP coverage.
“Instead, we had a stealth Medicaid expansion,” he says. “You did bring in the door people who were lower income, but once you got them in the door, you found out they were eligible for Medicaid.”
Lewis says the real discussion should have been whether it was a good idea to expand the existing Medicaid program.
State health officials and advocates for low-income people, however, say the focus should be on the effect of the program: Health coverage for thousands of children who before had none.
“I think that's absolutely a success story,” says Sarah Howell, executive director of Montana Women Vote, a coalition of groups that works to involve low-income women and their families in the political process. “It demonstrates a real need in Montana, that there are a lot of folks, working families with kids, or people with disabilities, who can’t find (affordable) coverage on the private marketplace.”
Dalton says kids with ready access to medical care are healthier, lead more active lives and do better in school.
“It has really done a tremendous amount of good since 2008, when it passed, and has helped us to produce healthy children and young adults, and we’re glad to be associated with it,” she says. “We still get thank-you cards from people (who were on the program).”
Oddly enough, many of the kids who obtained Medicaid coverage probably were already eligible for the program before the passage of I-155.
Heavy promotion of the program by the state and others, along with extensive coverage in the media, encouraged people to look into whether their kids were eligible for the program, state officials say.
The state also streamlined the application process, and word-of-mouth about the program helped it grow, too, says Jessica Rhoades, head of intergovernmental relations for DPHHS.