Montana legislature begin discussions on Medicaid

Yahoo

29-01-2025

Kaiden Forman-Webster ICT + MTFP
While many had the day off for Martin Luther King Jr. Day, the Montana Legislature was hard at work focusing on a number of issues affecting the state.
One particular committee meeting for public comment centered on tribal leaders and communities interests in Medicaid and its effects on tribes. The hearing room was jam packed with dozens of individuals ready to voice their concerns for reservations and the surrounding urban areas.
Many of those that attended the meeting at the Capitol had to drive multiple hours to ensure the chance to do so. Montanans know how roads can be during the winter and how difficult a high mileage trip can be.
Maria Roundstone, Northern Cheyenne, drove more than six hours to represent her tribe through hazardous conditions. She works for the tribes Revenue Department, which handles coding and billing with medicaid.
'It's a long travel,' Roundstone said. 'But looking back at our ancestors, we just had a Fort Robinson Run Breakout and that was from Nebraska and the kids actually run it.'
Roundstone was referring to the Fort Robinson Run Breakout, a 400 mile journey back to the Northern Cheyenne Reservation, done on foot to represent the original breakout of Fort Robinson by the Northern Cheyenne in 1879.
'So I mean for someone to run that far, all the way back to our reservation. Driving by car is not too bad.'
Others drove anywhere between two and five hours to attend the meeting. Todd Wilson, Crow, is the CEO of the Helena Indian Alliance, stressed the importance of attending in-person, saying it's always best to do so if possible.
While the discussion focused on the impact of the Medicaid expansion and the damage that would ensue immediately if the legislature fails to renew it for the state, multiple points of interest were continually focused on by those who attended.
Medical providers would see a major cut on all reservations and tribal residents living on reservations, often rural areas, would be put in the category of 'life or limb,' meaning if it doesn't threaten your life or one of your limbs to the point of amputation, it may be difficult getting medical attention.
Another main focus regarded the Tribal Relations Manager position that once provided a seat at the table in the Department of Public Health and Human Services. The position provided a tribal voice to speak on health issues affecting tribes.
Lesa Evers, Blackfeet, was the last to hold the position and retired in 2023. The position has since been left vacant by the department and was eventually removed entirely.
Dr. Anna Sorrell spoke strongly on this matter. She has a PhD in Indigenous and rural health and an extensive background of working for the state, the Confederated Salish and Kootenai Tribes, federal government, and was previously the director of Department of Public Health and Human Services.
State representative Mike Fox, a member of the American Indian Caucus, resides on the committee and asked about the Tribal Relations Manager position to get a clearer understanding of its importance.
It was at this time that Sorrell voiced her disapproval with the removal of the Tribal Relations Manager position.
'What I learned in that time was that if you're not sitting at the table, your voice is not heard,' Sorrel said. 'What the Tribal Relations Director position did at DPHHS, that was under the direct supervision of the Director, was keep our voice at the table every day for every issue.'
After the session was over, many individuals openly discussed the position, how they felt government-to-government relationships were during Evers time and how it had changed for the worse after she retired and the position was terminated.
During his time as Confederated Salish and Kootenai Tribal Health Director, Joe Durglo worked closely with Evers and has an intimate understanding of the communication she provided for tribes.
'She had a formal process that she used to go out and meet with the tribes directly. That was her formal process. She also shared her contact information, so if I ran into a problem with a particular pass order or a contract or had questions about specific things within the department, we could reach out to her directly,' Durglo said. 'So, she helped solve problems, she recognized the formal relationship between the State governments and the tribal governments. So she was very aware of that. She had a process where she presented information and representatives of that department to the tribes, formally in the government-to-government relationship.'
After Evers left Durglo added that it's been difficult to identify a person within the department to help solve problems and navigate the organization.
When asked about how a position similar should be designed, Durglo said it is important to work within and closely with the director.
'Tribes need to have a voice at that table, and that needs to be a tribal voice, not a state agency rep, speaking for us,' he said. 'We just need a voice in those decisions, in those conversations, and I guess vice versa, if the state or that department has questions from the tribe, she was also that liaison. She helped navigate, she understood tribes enough to help navigate that conversation going the other way. So it was a two way pact.'
Many want to see the position reinstated. Ted Russette, an enrolled citizen of the Cree Tribe and Vice Chair on the Chippewa Cree of Rocky Boy Executive Branch, said tribes have been left in the dark since her retirement.
'There was no cohesiveness after she left,' Russette said. 'Everything dropped, because she used to keep us, the tribes, informed about what was happening and what was coming down the pipe. After she left, nothing.'
The bureaucracy and the frustration that many people in the U.S. have towards it was echoed by Russette's frustration to the challenge of not being able to reach the right person in government, an issue many have faced in all facets of government.
For the issue of healthcare Russette had enough of the workarounds and came directly to the capital for answers.
'Finally, we just got to come up here and talked to the governor. Then he gets kind of mad at us. But what do you do?,' he said.
Mike Comes At Night, a more recently elected member of the Blackfeet Tribal Council, never interacted with Evers while she was in her position, yet still spoke on his thoughts about the communications with government-to-government relations.
'There needs to be communication between the tribe and state. A position similar to Lesa's would be a chance for that,' Comes At Night said.
Roundstone had communicated with Evers in the past and found her to be an integral part of keeping relations intact during her time at the department. Her office now faces the same issue of lack of communication and people suffer because of this.
'Reestablishing this position is instrumental to keeping tribes informed', Roundstone said.
From the many voices that described just how influential Evers and her position was, understanding how she created the communication pipelines needed for government-to-government relations will be paramount to this position if the department reinstates it once again.
During her tenure, Evers explained the efforts she made to do so. She consistently went to each of Montana's reservations to get contacts from every tribe and also took individuals from the many health departments to the reservations to create relationships between all parties.
It was important to her to maintain open and honest lines of communication, even when the news may not have been favorable to tribes.
'I saw tribal governments as partners in our work, communicating with them, keeping them informed about the position that the department had on things which sometimes wasn't favorable to them. You know, being honest, there was a lot of things that I did,' Evers recalled. 'I did tribal tours every spring and fall, I went out and I met with every single tribal government in their chambers. Met with health facilities, the health CEOs, executive directors, and I took staff with me. I would take the Medicaid director. I've taken previous directors, deputy directors, other leadership in the agency, to have that experience out in Indian Country, to sit in tribal chambers and have this formal conversation all the way to Fort Peck, or over to Browning, or wherever it might be. But we did this trip every spring and every fall.'
Evers office was two doors down from the director's and she credits working in such a close proximity to the success she was able to have.
The funding is still available for a position of similar status. Republican state senator Dennis Lenz wondered why the position went away and where those responsibilities now lie.
'Have some of those functions been dispersed throughout the department? I mean did the actual function get dispersed? I can't speak to why he would have done that. That is kind of unusual,' Lenz said.
A letter signed by all members of the Montana American Indian Caucus will be submitted voicing their displeasure with the removal of the position and hope to see it reinstated once again in the department.
A representative from the Department of Public Health and Human Services declined to be interviewed for this story.
This story is co-published by Montana Free Press and ICT, a news partnership that covers the Montana American Indian Caucus during the state's 2025 legislative session