- Associated Press - Wednesday, August 26, 2015

The Billings Gazette, Aug. 21, on health coverage for Montanans:

Getting the federal government to make exceptions to Medicaid law - as allowed by the Affordable Care Act - requires Montana to prove its case in complex negotiations.

But for the crowd gathered Tuesday at Billings Public Library, the argument is straightforward and urgent: Up to 70,000 uninsured Montanans need the coverage.

One of those Montanans is a patient that Dr. Brandon Smith treated recently at RiverStone Health for heart failure. Smith, a Chouteau native and second-year family medicine resident, told how he had treated a man who needed an echo cardiogram, a test that RiverStone doesn’t provide. If the patient had private insurance, Medicare or Medicaid, it would have been a quick and simple matter to refer him to another providers. But the patient had no coverage.

The meeting to gather public comment on the state’s effort to have some federal rules waived to get low-income Montanans covered also brought out stories of struggle from:



- A single mother raising four kids on her own, who can’t afford private insurance, but makes too much money to qualify for Medicaid. Parents of young children presently can only qualify if their income is less than half of poverty level.

- A college student who bought student health insurance, but can’t afford to get sick when not in school.

- The mother of a young man with diabetes who moved out of state and quickly got enrolled in Medicaid until he got a job and started buying his own health insurance.

- A son who suffered seizures for years, but didn’t qualify for Medicaid until after he suffered a spinal cord injury during a seizure.

- A mother who had no insurance when diagnosed with cancer.

- A son who quit his job and lost his health insurance while caring for his ailing father.

- A worker who cares for people with disabilities, but has no health insurance himself.

- A man who lost health insurance when he was laid off.

- A Crow Tribe member who cited the “woefully underfunded” Indian Health Service as the reason Montana tribal members need access to Medicaid.

A previous Gazette opinion called on the Centers for Medicare and Medicaid Services to promptly approve Montana’s waiver requests when they are submitted in September. After three years of fighting for the Montana Legislature’s approval, the same advocates are telling CMS to allow Montana’s HELP plan to work.

Underscoring the economic self-help provisions of the HELP Act, Pam Bucy, state commissioner of labor and industry, described the work by various state departments to prepare for outreach and training new Medicaid enrollees to get good jobs.

“We are on target to launch this program on Jan. 1,” Bucy said.

CMS already has approved waivers for five other states that are similar in principle to what Montana’s law requires. The unique feature of the Montana plan is contracting with a private company to administer benefits for some of the new enrollees. Four companies have submitted proposals to do that job: Allegiance Benefit Plan Management Inc., Blue Cross Blue Shield of Montana, PacificSource Health Plans and Sanford Health Plan. State health officials have said they hope to award a contract by Oct. 1, and - if CMS approves the waivers - start providing health care to newly covered Montanans on Jan. 1.

The third-party administrator feature certainly qualifies as an opportunity to test how that arrangement works with Medicaid. It should work much like a private insurance plan, so Medicaid enrollees will become familiar with the private system they can move into as they get better jobs and their income increases. The Montana Children’s Health Insurance Plan has used a third-party benefit administrator since its inception two decades ago.

As Rep. Jessica Karjala, D-Billings, said Tuesday, the need for covering Montanans is clear. “We must provide coverage for folks in the gap and encourage labor force participation.”

Editorial: https://bit.ly/1JdZ13n

___

The Independent Record, Aug. 23, on funding for access to public lands:

Outdoor recreation is a key piece of Montana’s economic puzzle. People are attracted to visit our state because of its natural beauty and the abundant public access to our unique wild places. Businesses set up shop here for some of the same reasons and because an employer knows that it’s easier to attract potential employees to places that have great recreational opportunities because that adds tremendous value to the overall quality of life.

Montana has this in spades.

A look at our own community, with its incredible and internationally recognized trail system, and access to public lands, proves this point. Our economy and quality of life depend on the public lands and wild places right outside our door.

What many people may not know is just how much a specific federal fund has contributed to the preservation of and access to these lands and places.

The Land and Water Conservation Fund was approved by Congress 50 years ago and is funded primarily by a tax on royalties from off-shore oil drilling. The LWCF can have $900 million allocated to it annually, though the average allocation has been far less. Still, the fund is responsible for many projects in Montana and around the Helena Valley.

This past summer the Lewis and Clark National Forest grew by about 8,200 acres with the Tenderfoot Creek Project that was a joint effort between the Bair Ranch Foundation, the Tenderfoot Trust, the Rocky Mountain Elk Foundation and the Forest Service. The $10.7 million project found the large bulk of its funding from the LWCF.

The LWCF has two primary programs for allocating money: the federal lands protection program and state assistance program. The federal lands protection program is used to acquire and protect land for the public’s use. The state assistance program provides matching grants to states and local communities to protect parks and recreational resources. It’s a 50/50 matching program, so to qualify projects must have a significant investment from local communities and citizens.

Through the state assistance program, Montana has received about $38 million in the last 50 years, according to the LWCF Coalition.

In Lewis and Clark County, popular spots that have received funding from LWCF include the Lewis and Clark County Fairgrounds, 10 city parks, Bill Roberts Golf Course and the East Helena Pool. In total, the LWCF has provided more than $1.65 million for vital community projects just in Lewis and Clark County alone.

Across Montana, we have benefited from about $540 million in LWCF money.

But written into the initial act creating the LWCF was a sunset clause, which means if the fund isn’t reauthorized by Sept. 30, it will cease to exist and this tool Montana has used to help fund community projects, grow our economy and protect important wildlife habitat and open space will be gone.

Fortunately for us, our entire congressional delegation is strongly behind the permanent reauthorization of LWCF. Rep. Ryan Zinke is a cosponsor of legislation in the House that would accomplish this, and both Sens. Jon Tester and Steve Daines are cosponsors of legislation in the Senate that would do the same. Both pieces of legislation would also direct 1.5 percent of the LWCF annually to go toward public access projects.

We applaud our delegation for getting behind this nonpartisan issue and seeing the value of public lands and outdoor recreation to Montanans. We urge Congress to move this issue forward ahead of the Sept. 30 deadline in any way possible, whether it is the passage of actual legislation to accomplish the reauthorization or it is as a rider on another bill. Beyond just reauthorization, it’s incumbent on Congress to honor the intent of the original legislation and the overwhelming sentiment of Montanans and Americans and fully fund LWCF to $900 million and allow the good work that the fund has accomplished to continue.

The important thing is to get it done.

Editorial: https://bit.ly/1MIxDPE

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