TL/DR –
Montana’s largest county healthcare organization, RiverStone Health, is cutting 29 staff positions due to a loss of over $3 million in Medicaid funds and challenges with Medicaid reimbursement. The organization has seen a drastic decline in its Medicaid-enrolled patients, largely due to complications in the “unwinding” or redetermination process, which verifies a patient’s qualification for Medicaid coverage – a process that has resulted in many being disenrolled due to procedural issues, often paperwork-related. The situation has led to an increase in uncompensated care, which RiverStone Health, as a federally-qualified health center, must provide regardless of a patient’s ability to pay.
Montana RiverStone Health to Cut Staff Due to Medicaid Issues
Montana’s RiverStone Health has announced the cut of 29 staff positions within the next month, attributing the job losses to the Medicaid “redetermination” process and reimbursement challenges. The public health organization has suffered more than $3 million in Medicaid losses leading to the reductions. Overall, nearly 9% of its workforce has been cut, including employees from closed programs and consolidated leadership roles.
The Medicaid redetermination process in Montana has been two-fold. Despite increased reimbursement rates for providers in 2023, organizations reported that reimbursements lag months behind and many lost healthcare coverage due to paperwork issues. The state has seen the highest percentage of children dropped from Medicaid.
RiverStone Health, a federally-qualified health center, has witnessed a drastic decline in the number of enrolled Medicaid patients. The community health arm provides essential medical, dental, and behavioural healthcare, regardless of a patient’s ability to pay. However, the loss of Montanans’ health coverage due to Medicaid unwinding process inefficiencies impacts the viability of both patients and staff.
The organization revealed that affected employees would get a 30-day notice, access to assistance and support service, and they can also apply for any internal vacancies. RiverStone serves around 14,000 patients with different payment methods, including Medicare, Medicaid, self-pay, and private-pay insurance. The health center has seen a 6% budget hit due to over $3 million in uncompensated care from around 1,600 patients losing coverage.
Despite the challenges, a recent poll showed that 80% of Montanans favor Medicaid. Reports also indicate that the costs of Medicaid for Montana have remained flat, while the state has implemented less expensive preventative services. Furthermore, Montana is recognized for successfully bargaining for Medicaid work-requirements, with 97% of the enrolled residents either working part-time, disabled or taking care of family members.
Despite these positive developments, providers have reported widespread reimbursement delays. Larger clinics, like RiverStone, experienced these delays earlier, with some waiting more than a year for reimbursement. Although the issue has been largely resolved, some smaller providers still report an eight-month wait.
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