Whether or not you support the federal health-care reform law, the special dispensation given to help Libby asbestos victims is a vital step in providing care for some very sick people.

Due to asbestos exposure over several decades from the former W.R. Grace & Co. vermiculite mine, the federal government declared Libby a public health emergency in 2009. That opened the door for the Libby Provision, allowing people who acquired diseases from that hazard to become eligible for Medicare under a provision of the Affordable Care Act.

The Libby Provision provides traditional Medicare coverage for Libby asbestos patients even if they’re under 65. It also provides access to competitive grants for ongoing screening.

A third prong of the Libby Provision began July 1, offering additional benefits previously provided by temporary state and federal grant programs to asbestos victims who reside in Flathead and Lincoln counties.

Sounds good on the surface, but is limiting coverage to residents of two counties a fatal flaw in the pilot program? What about Libby asbestos victims living in other places in Montana or out of state? Are they supposed to return to Northwestern Montana to be tethered here where all their health problems began?

As the outreach coordinator of the Center for Asbestos Related Diseases, or CARD clinic, in Libby aptly pointed out, many asbestos patients who are still well enough to work have left economically depressed Libby to work in places like the booming North Dakota oilfields. That means they’re cut off from coverage under the pilot program that includes a number of services not covered by Medicare: Special medical equipment, nutritional supplements, additional prescription drugs, home-care services and help with travel expenses to get care.

The pilot program is kicking in just as other programs that provided the same kind of care have ended. In at least one case, a victim’s oxygen tank was stripped away before he could pursue other options to continue getting care. He lives in Lake County, so he is out of luck for the pilot program.

We believe the criteria for using the Libby Provision pilot program should be similar to the criteria set up for the original asbestos screening program and include anyone who lived, worked, played or went to school in Libby for at least six months before Dec. 31, 1990.

To his credit, Sen. Max Baucus, D-Mont., fought hard for what has been called the “Libby fix.” This residency issue with the pilot program seems like something the senator might want to have a hand in fixing as well.