AG Fox Sits Down With Stat Air, Hospital to Discuss Health Care

Attorney General and gubernatorial candidate, Tim Fox, on Feb. 27 met with local health care administrators to tour the state-of-the-art Stat Air Ambulance hangar and discuss health care policy, insurance and Medicaid funding.

Fox met with Frances Mahon Deaconess Hospital CEO Randy Holom and Northeast Montana Stat Air Co-op Executive Director Clay Berger. The group started by touring the facility, which features a series of twin-prop ambulances, a large classroom, lodgings for on-call staff and it even houses a flight simulator that can replicate a wide-array of different planes.

Berger told the attorney general that they were in the process of having the simulator upgraded and certified with the FFA to avoid paying thousands to send pilots to simulator training in the future. Berger also highlighted the Co-op’s unique status in the state. As far as any of the two health care administrators knew, the Northeast Montana Co-op is a unique model for ambulance services.

The idea was the brain-child of Holom who noticed that when FMDH was the sole owner of the ambulance service, it was hardly utilized by other regional hospitals. So, the CEO gathered the hospitals and worked to get each to have an ownership interest in the air-ambulances to incentivize its use. According to Holom, the idea has worked well as use is up and the non-profit ambulance can often save patients money since it avoids calling a service out of Billings.

After showing off the co-op’s facility, Fox sat down with the two men to discuss policy issues facing the ambulance service and the hospital. Among them was the issue of Medicaid reimbursement rates. Berger showed how Medicaid rates—set by the state government—had been underpaying, specifically, for air-ambulance services. The state sets their rate at as low as $3,500 and according to Holom the private pay rate is closer to $20,000, a dramatic difference since many in the region have been moved under the umbrella of Medicaid expansion.

Fox pointed out that what the two men were saying was that Medicaid expansion had actually hurt air-ambulance services' “bottom line.”

Holom pushed back and stated, “Our hospital’s formal position is we are supporting Medicaid expansion. We think it has done far more good than harm.” He also pointed out that the expansion is not the problem as much as the rates set by the state—either through the Department of Health and Human Services administrative rules or through the legislature. On the issue of rural health care, Holom stated pointedly, “We’d like to see some help from the state.”

Also on the agenda was the issue of medi-share plans, which bill themselves, “not insurance,” by pooling money from a large enough group in order to spend that money on health care. As med share programs stand right now, they are unregulated and Berger stated they have, in some cases, tried to avoid paying expenses associated with air-ambulances.

Medi-share policies were previously banned in the state since they were often difficult to regulate and guarantee at a state government level. Under the leadership of current Insurance Commissioner Matt Rosendale (R), the plans were legitimized in 2018 and made available to the Montana public. They were previously banned in 2007 for fraudulent business practices that often left many unable to pay for medical costs.

The director of the Montana Nurses Association accused Rosendal in a Missoula Current article of, “deceiving state residents by allowing a once-banned health-care ministry back into the state, and disguising it as a legitimate option to a regulated insurance policy.”

Berger and Holom both pushed back on medi-share policies and the problems they pose. Berger stated that there are, “problems with [medi-shares], especially when [the co-ops] don’t have any teeth to go after [money due] in Montana.”

Holom went further than medi-shares and pushed back on the idea of allowing the deregulation of inter-state insurance plans, a move he thinks would remove the ability of Montana to have a voice in insurance regulation. He said the, “push to allow cross border sales of insurance would be a detriment [to the state],” since it would take away Montana’s voice in regulating policies.

Fox acknowledged that it was outside his office’s purview to pursue insurance scams and regulation, but he did point to the department’s Office of Consumer Protection, which he said could pursue cases of business fraud and scamming.