Strengthen existing instead of adding new bureaucracy

It’s helpful to be at the same line of work long enough to be able to be proven wrong. I’ve been working with National Alliance on Mental Illness Montana to improve Montana’s mental illness treatment system for the past 10 years. We’ve been really active on the local, state and national levels. That amount of work has brought plenty of opportunities to be wrong, and we haven’t been able to avoid them all. One of the biggest times that I was wrong was on Medicaid expansion during the 2015 legislative session.

NAMI Montana fully supported Medicaid expansion, but I personally didn’t believe it would be helpful to that many Montana veterans. As a veteran who works on veterans’ issues, I’m hypersensitive to veterans being used as pawns by political parties or anyone else pushing a political agenda. I thought that the potential benefit to Montana veterans was being oversold.

Medicaid expansion passed the Legislature in 2015. In the following years, I was proven wrong about its value to veterans. I will never forget the first time I referred a Montana veteran to Montana’s Medicaid Expansion program. The Veterans Administration wasn’t a fit for them and they were struggling to transition to civilian life. Medicaid was there for that veteran and that veteran wasn’t an anomaly.

A snapshot from a single health center demonstrates the point. PureView Health Center in Helena served 418 veterans in 2018. Seventeen percent of those veterans had Medicaid as their primary insurance. That is exactly what Medicaid expansion advocates said would happen in healthcare centers across the state. I didn’t believe them, but they were right. Now we must make sure that this successful program continues in its current form. At this legislative session, Medicaid expansion advocates are really worried about bureaucratic requirements to report on work activities will make it harder for thousands of Montanans to access healthcare. It’s tempting not to believe them. Everyone that NAMI Montana has directed to Medicaid expansion has been in the workforce, so in theory the work requirement shouldn’t be a problem. The reality is the Medicaid work requirement would lead to a major investment in a “work requirement tracking” computer system with some type of “online work tracking” portal and significant efforts by the Department of Public Health and Human Services to try to quantify how many hours individual low income Montanans are working. This predictable bureaucratic nightmare will lead to people losing health insurance when they most need it. It’s been a mess in other states and it will be a mess here.

We are better off strengthening Montana’s existing Health and Economic Livelihood Partnership Link (HELP-Link) which provides workforce training to unemployed Medicaid enrollees who face barriers to work such as limited skills and lack of access to support such as childcare and transportation. HELP-Link has already reached 25,000 Montana Medicaid recipients since its launch. It’s helping more people join the workforce. Achieving the same goal as the work requirements, but without the bureaucratic-technical train wreck.

— Matt Kuntz, J.D., Executive Director, NAMI Montana