Citing challenges with the Medicaid “redetermination” process and reimbursement, Riverstone Health, the community health department for Montana’s largest county, announced it will cut 29 staff positions over the next month.
In a press release Friday, Riverstone Health is taking steps to reduce its budget, but after incurring more than $3 million in Medicaid losses, the cuts will be finalized in mid-June before the end of the organization’s fiscal year. He said that it is planned to be done. .
The healthcare provider, which has a large presence in downtown Billings, announced it has cut nearly 9% of its workforce across the organization, including those who were laid off after the closure of some programs. These include rural school travel nursing programs and inpatient hospice care.
“Due to these challenges, several senior leadership and management positions have also been consolidated or eliminated,” the press release states. “Rising costs, lower-than-expected patient volumes for primary care services, and stagnant reimbursement rates are exacerbated by the Medicaid redetermination process that began in April 2023.”
In Montana, the redetermination process was twofold. The Montana Legislature increased reimbursement rates for providers during the 2023 session, but lawmakers have heard from organizations in the state that reimbursements are being delayed for months. Additionally, Montana’s “redetermination” rate (which measures the number of people in the state who remain enrolled in Medicaid) is declining at a higher rate than expected, with many people losing their health coverage due to lack of documentation. It has become. Montana also has one of the highest rates of children dropping out of the program.
“Despite efforts to keep all eligible Montanans enrolled in Medicaid, Riverstone Health has seen a decline in the number of patients enrolling in Medicaid, even though most patients are still eligible for Medicaid. has significantly decreased,” the release states.
RiverStone Health is a federally qualified health center that provides medical, dental, and behavioral health care regardless of a patient’s ability to pay.
“However, as more Montanans lose health insurance due to inefficiencies in the Medicaid cancellation process, the burden of this unpaid care is impacting the lives of both patients and staff,” Riverstone’s statement reads. Stated.
The Montana Department of Public Health and Human Services did not respond to a request for comment Friday afternoon.
RiverStone said affected employees will receive a support package that includes 30 days’ notice, access to assistance and support services, and be able to apply for any internal vacancies.
“Everyone affected by these reductions plays a critical role in protecting life, health and safety,” said John Forte, President and CEO of Riverstone Health. I am. “Eliminating these positions does not take away from the incredible difference they make in serving our communities.”
Losses in Montana in particular were higher than normal. Ten million people nationwide have lost Medicaid coverage since the process by which states identify Medicaid-eligible patients following a pandemic-era enrollment freeze, but between April and December 2023, 10 million people have lost Medicaid coverage. Montana had the highest percentage of children disenrolled. to the Centers for Medicare and Medicaid. Cover Montana, an organization created to stem the number of people losing insurance, said 64% of people who have been “uninsured” do so for “procedural reasons.” In many cases, it is simply a lack of documentation.
Forte said nearly 70 percent of Riverstone’s patients have had their registrations canceled due to administrative issues.
“We’ve had some of our patient care coordinators double-booked, triple-booked, trying to help as many patients as possible,” Forte said. “They waited hours on the phone and stood in line for hours at state aid facilities.”
Forte said RiverStone Health has about 14,000 patients with a mix of Medicare, Medicaid, self-insurance and private insurance. Approximately 1,600 patients have lost insurance coverage, resulting in more than $3 million in uncompensated treatment. This represents over 6% of Riverstone’s budget.
In either case, the clinic or hospital like Riverstone does not have the power to refuse treatment, leaving the organization with an uncompensated loss. Forte said Riverstone’s customer base is highly dependent on Medicaid, but he believes other hospitals and health systems may face similar losses due to uncompensated care. said.
“We never turn away individuals because they cannot afford to pay,” Forte said. “We’re just falling into a negative trend. But at a time when we need a strong health workforce and access to health care, we’re being forced to reduce quality, dedicated staff.”
Despite the cuts, Medicaid in Montana has garnered equally strong positive support from residents.
A poll released last week found 80% of Montanans support Medicaid and increased reimbursement for institutions ranging from hospitals to nursing homes.
While most premiums have increased, Montana’s Medicaid spending as a share of the state budget has remained flat, according to the Montana Health Care Foundation’s annual report released this week.. Additionally, more expensive inpatient and emergency department services are being replaced by less expensive preventive services.
Finally, Montana was singled out as perhaps the only state in the country that has successfully negotiated work requirements for Medicaid enrollees. The program required some work or retraining to maintain enrollment. According to the same Montana Health Care Foundation report, nearly 97% of Montana residents enrolled in Medicaid are disabled and work at least part time or spend full time caring for other family members. I am.
In addition to residents losing insurance, providers are also reporting widespread delays in provider reimbursement across the state. Forte said large clinics like Riverstone experienced some delays early in the “redetermination” process, but the state has largely resolved them. He said there were times when Riverstone waited more than 12 months for reimbursements for some patients. But some smaller providers are still reporting eight-month waits, he said.
