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A mother’s meds that kept her anxiety at bay enough to focus on her children’s needs are gone. The oldest child now shoulders the family responsibilities and school personnel notice the downward change in her personality and grades.

An elderly man with early dementia stares at his Medicaid renewal notice and wonders why the medical bills are piling up.

Conscientious adults cut their own, and their children’s, medications in half to “stretch” them, aware of bad effects, yet feeling they have no other choice.

Vulnerable people who gathered to socialize daily, now hide inside lonely apartments feeling betrayed by their once supportive community.

These and other stories were collected by the Beaverhead County Mental Health Local Advisory Council after budget cuts last year: our county lost four local links to vital public service programs, making us one of the hardest hit counties. We gathered data via surveys and consumer meetings to prioritize needs to know where to first respond. “Help us get and maintain our programs so we don’t lose our food and health care and can find jobs!” was the dominating cry. A temporary emergency Resource Assistance Center was established with space donated by the County commissioners, office supplies by United Way, and staffing needs through both Action, Inc. and Headwaters Healthcare Foundation. Representative Tom Welch helped assure that a trained staffer comes from the Butte office of public assistance one day a week. We exist in this “finger–in–the-dike” emergency response mode awaiting the outcome of this year’s legislative session.

We know that securing all lost local access to services isn’t likely. However, we expect our legislators to support and advocate for state investments in long-term solutions to health care access in Montana, especially Medicaid expansion.

The legislature needs to lift the June 2019 sunset and prevent any harmful changes to Medicaid expansion that would kick people off coverage when they need it most. Expanded Medicaid has been a vital source for health care coverage for nearly 100,000 Montanans and a lifeline for individuals with substance use disorders and mental health conditions – especially in Beaverhead County.

About 800 Beaverhead County residents are enrolled in Medicaid expansion. The vast majority are young, working or in college, and still unable to access insurance through an employer. Harsh work and reporting requirements that threaten withdrawn coverage would endanger the health and recovery of folks with serious mental illnesses. Medicaid expansion is a critical tool for Montana to more effectively deliver and pay for behavioral health services. Of the 800 Beaverhead residents enrolled in Medicaid expansion, nearly 400 have received some sort of mental health or substance use disorder treatment. What will their and their children’s lives be without this? Stopgap measures to assist in enrollment will not be of any use if there is no program.

Jobs, especially those with health benefits, are hard to come by in Beaverhead County. This is evidenced by the fact that in our county 179 businesses employ at least one person enrolled in Medicaid expansion. We believe in helping people who can work find good jobs, but eliminating health coverage if they do not meet strict requirements is the wrong way to help people access better work. Taking away people’s coverage makes it harder for them to work and succeed in today’s economy.

Rural Montana has seen economic benefits, via Medicaid Expansion, on critical access hospitals and local economies. Beaverhead is no exception. No rural hospitals have closed since 2015, because expansion has been a lifeline for health care access in rural Montana. If people lose their health coverage, rural hospitals will see their uncompensated care costs increase, making it harder for hospitals to survive, and putting health care for the larger community at risk. Information shared recently from Barrett Hospital and Healthcare (BHH) indicates that there were 480 Beaverhead county residents who received services from BHH last year via Medicaid expansion. These are working adults previously without coverage because of limited income, yet too much income for standard Medicaid. As a civilized state of caring people, do we really want these 480 people to go back to having no medical care?

Medicaid expansion is a bipartisan compromise that doesn’t need any more red tape. The numbers prove this program is working and is a critically important investment for the future of our rural communities. Medicaid expansion is the best opportunity we have to address Montana’s mental health crisis, invest in our rural community hospitals, and help people get back on their feet when times are tough. Times have been tough in 2018 and 2019: Beaverhead County residents already feel forgotten by our state. Do not turn your backs to them again by cutting Medicaid expansion.

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Jerry Girard chairs the Beaverhead County Mental Health Local Advisory Council. Lynn Weltzien is the former chair (2016-2018).

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