Health care access mired in red tape 

Montana’s low-income families face a host of difficulties when trying to get health insurance coverage for themselves and their children, but not because of a lack of available services, says Montana People’ s Action (MPA), a Missoula non-profit advocacy group for the interests of low-income citizens.

Instead, about half of all uninsured children in Montana—about 27,600 children—go without basic medical coverage simply because their parents cannot navigate the lengthy and confusing application process, or else are never told that programs for them even exist, says MPA in a recent report entitled “No Healthy Start in Montana.”

The report documents the experiences of 25 families over a three-month period as they applied for Medicaid or the Children’s Health Insurance Program (CHIP).

MPA identifies several barriers that the families encountered when trying to enroll in these programs—barriers MPA says could be easily removed by the Department of Public Health and Human Services (DPHHS), the state agency that administers these programs.

Among the barriers is an application process that the families say is lengthy, confusing and time-consuming, such as a Medicaid eligibility form that runs 17 pages long, and a CHIP application form that runs eight pages. Although the state had adopted a shorter, seven-page “universal form” that would cover both programs, the form was deemed unacceptable by the Legislature’s Interim Committee for Children and Families, so only a few thousand forms were ever printed.

The report also reveals that applicants for Medicaid and CHIP are often given incorrect or misleading information or are never informed of their rights. Moreover, low-income advocates say that the Medicaid interview process can be both inflexible and discriminatory against working families. For example, applicants for Medicaid can be deemed ineligible if they own assets totaling more than $3,000, which can include a second car or motorcycle used for commuting to work.

The CHIP program has also been criticized for its spotty outreach program, which, according to the latest figures from DPHHS, has enrolled only 5,200 children in the last year, out of the 10,000 slots available. Meanwhile, one out of four Montana children lives without health insurance.

“Our main focus is that we have these programs out there but people don’t know they’re available,” says MPA’s Nina Cramer. “Regardless of how much paperwork you have to do, [DPHHS] hasn’t done a good job promoting the programs.”

The report recommends that the state streamline the application process, provide clearer and more consistent instructions to applicants, train case workers in providing better information, and initiate a more aggressive and diversified outreach program.

Before releasing the report, MPA met with DPHHS Director Laurie Eckanger, who is expected to issue a formal response or recommendation later this week.

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