Montana State Legislature

Medicaid Expansion (HELP Act)

Medicaid Expansion

At its first meeting in June 2017, the Children and Families Committee decided to devote a substantial amount of time to reviewing Montana's Medicaid expansion program. The committee adopted a schedule of activities at its September 2017 meeting.

Legislators in 2015 passed Senate Bill 405, the Health and Economic Livelihood Partnership (HELP) Act, to authorize expansion of the Medicaid program as allowed under the federal Patient Protection and Affordable Care Act. Among other things, SB 405:

  • required that expansion enrollees pay a premium equal to 2% of their income;
  • required that enrollees with incomes of 101% to 138% of the federal poverty level be disenrolled from Medicaid if they failed to pay premiums;
  • required enrollees to pay a "taxpayer integrity fee" if their assets exceeded a certain level;
  • required the state to use a third-party administrator to administer the expansion program and create a network of providers for expansion enrollees to use; and
  • gave enrollees the option of participating in wellness and workforce development activities.

The federal Centers for Medicare and Medicaid Services (CMS) limited the premium and TPA requirements to people with incomes above 50% of poverty.

In January 2018, members reviewed demographic data on the people who qualified for Medicaid expansion and information on the number of people who have participated in the voluntary workforce development aspects of the HELP Act. They also received information on the HELP Act and on the waivers that CMS approved for the Montana program. In March, they learned about CMS approval of waivers that will allow other states to require that enrollees participate in work or other community engagement activities and that will allow other changes to the Medicaid programs in those states. The committee also heard from health care providers about how Montana's expansion program has affected their organizations and their patients. Individuals who have participated in the expansion program and in the workforce activities have also spoken to the committee.

The committee in May heard a presentation on the economic impact of Medicaid expansion in Montana and also reviewed a list of potential legislative changes to Montana's law. Members asked that a bill to eliminate the HELP Act Oversight Committee be drafted for review and public comment at their June 2018 meeting.

In June, the committee approved the bill draft for introduction in the 2019 legisaltive session. They also received information on the expected costs of the expansion program if it's continued after June 2019.

Draft Legislation

  • LCCF10: Eliminate the HELP Act Oversight Committee

Staff Reports

Related Links and Study Materials

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