Montana releases health care waiver plan

Jul 07, 2015

This morning, the state of Montana released its draft plan to expand health care coverage under the recently-passed HELP Act. For a refresher on the process and timeline, see our report on the waiver process here. Montana is required to submit this plan (formerly called a 1115 waiver) to the federal government for approval. But before that, the state will solicit feedback from Montanans during a 60-day comment period. You can find more information on how to submit a comment on DPHHS’s website. The State will also hold two public forums in August, where individuals can attend and share their comments with Department staff. However, the public can comment in writing or by email at any point directly to DPHHS during the 60-day comment period. What is included in the draft 1115 waiver? The draft was just released, so MBPC will be taking a closer look over the next few days, but here is what we know. The draft waiver reflects the provisions included in the HELP Act, expanding coverage to adults up to 138 percent of the federal poverty line, with roughly 70,000 Montanans now available for coverage. The waiver includes detail on the HELP Act’s requirement of premiums and copays for newly enrolled participants. These payments combined will never exceed 5 percent of the family household income, which is the maximum allowed under current Medicaid law in Montana. The waiver will also explain that for individuals above the poverty line that fail to make these payments, they will lose coverage until those payments are made or the debt has been assessed by the state. (The HELP Act also requires the state to assess failed payments by those below the poverty line, but because it will not impact health coverage, this is not an issue for the waiver.) Interestingly, the state is also requesting a waiver to streamline eligibility process by using existing verified income information provided through the state’s Supplemental Nutrition Assistance Program (SNAP). Nationally, more than 80 percent of individuals eligible for SNAP participated in the program in 2010, so using SNAP information to determine eligibility for Medicaid is an efficient way to reach thousands of Montanans who we already know meet the income eligibility requirements to receive coverage under the HELP Act. What happens after the state comment period? Following the state 60-day comment period, the state will then submit its updated waiver to the federal Center on Medicaid and Medicare Services (CMS). The state must include a summary of the comments it received during the state comment period. CMS must then meet the federal timeline, including a separate comment period of 30 days. It is unclear exactly how long the entire federal process will take, but it is expected to take several months. (Montana’s draft waiver is requesting that coverage begin on January 1, 2016.) CMS has previously approved Medicaid expansion waivers in Arkansas, Iowa, Michigan, Pennsylvania, and Indiana, and has approved many of the same provisions that the HELP Act provides. The 1115 waiver that Montana has released reflects the negotiated bipartisan bill that the legislature passed and the Governor signed. While it may not be perfect, it provides much-needed health care coverage to tens of thousands of Montanans who have been waiting years. This is an opportunity for the public to provide its feedback on the details included in the waiver, but most importantly, to reiterate the support we witnessed during the session for expanding health care coverage to Montanans who need it. Time is of the essence, and we hope the state and CMS will move as quickly as possible to begin providing coverage that so many Montanans desperately need.  
Montana Budget & Policy Center

Shaping policy for a stronger Montana.

MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.