Medicaid Expansion (HELP Act)
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.
- LCCF10: Eliminate the HELP Act Oversight Committee
- Potential Considerations for Action, May 2018
- Work Requirements and Other Federal Changes, March 2018
- Workforce Activities, January 2018
- Enrollee Demographics, January 2018
- Selected Statistics to Date, January 2018
- Key Elements of SB 405, November 2017
- Comparison of SB 405 and CMS Waivers, November 2017
- Medicaid: An Overview, August 2017
Related Links and Study Materials
- HELP-Link Program Update, Department of Labor, June 2018
- DPHHS Budget Outlook, Legislative Fiscal Division, June 2018
- The Economic Impact of Medicaid Expansion in Montana, Bryce Ward and Brandon Bridge, University of Montana Bureau of Business and Economic Research, May 2018
- Exploring the Medicaid Reform Landscape, Kathleen Nolan, Health Management Associates, March 2018
- Expansion Impacts on Montana Hospitals, Montana Hospital Association, March 2018
- Congressional Proposals to Reduce Federal Medicaid Funding: Considerations for Montana, Deborah Bachrach, Manatt Health, September 2017