Montana State Legislature

Medicaid Expansion

The 2019 Legislature passed House Bill 658, to continue the expansion of Medicaid to nonpregnant, nondisabled individuals who are 19 to 64 years of age and who have incomes of 138% or less of the federal poverty level. HB 658 requires many of the expansion enrollees to complete or other community engagement requirements and to pay premiums that gradually increase if they remain on Medicaid for more than 2 years.

Those provisions can't go into effect unless the federal government waives some provisions of federal law. The Department of Public Health and Human Services is required by law to present its waiver application to the Children and Families Committee for public comment before submitting it to the federal government. DPHHS did so at a July 30, 2019, meeting.

The Centers for Medicare and Medicaid Services has not yet acted on Montana's application, although it has approved similar requirements in other states. Those approvals have been challenged in court, and a federal appeals court has vacated the approval given to community engagement requirements in Arkansas. The appeals court said the federal government failed to consider the potential loss of Medicaid coverage that could occur if the requirements were in place. 

The federal government has appealed the decision to the U.S. Supreme Court, which has not yet made a decision on whether to accept the appeal.

Staff Materials

• Summary of Appeals Court Ruling, May 2020
• Status of HB 658 Implementation, January 2020
  • Legislative Fiscal Division Medicaid Monitoring Reports
    • August 2020
    • June 2020
    • December 2019
    • September 2019

DPHHS Materials

• Full Section 1115 Demonstration Application and Extension (295 pages)
  • Waiver Application Only (38 pages)
  • Appendices
• PowerPoint: Medicaid Expansion Waiver
• Medicaid Expansion Interactive Dashboard