Policy & Regulation News

Medicaid Expansion Bill, HELP Act, Signed by MT Governor

By Jacqueline DiChiara

- Medicaid coverage is multiplying for low-income beneficiaries via the Montana HELP Act.

Medicaid Expansion Bill

Bipartisan legislation (SB405) was recently signed by Montana Governor Steve Bullock, expanding Medicaid coverage to residents between the ages of 19 and 64 with incomes falling below 138 percent of the federal poverty level (FPL), which amounts to an approximate annual income of $28,000 for a family of three, confirms data from the Henry J. Kaiser Family Foundation (KFF). Through the enactment of this legislation, premiums paid by those beneficiaries enrolled in the Medicaid expansion plan will match 2 percent of their income.

The legislation additionally mandates Medicaid program reforms and fosters job training, readiness opportunities, and tort reform regarding contract for injury or death in association with alleged professional negligence.

The new law and program initiatives may garner federal approval with enactment beginning by early next year, confirms An Association of Montana Health Care Providers (MHA).

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  • States MHA President, Dick Brown, “SB405 passed due to the unwavering commitment of several advocacy groups working together with Democratic and moderate Republican legislators to find a Montana solution to cover 70,000 of our neighbors.” Brown adds he is proud of the role MHA played in helping SB405 pass.

    Mind the ACA gap

    According to KFF, as of April 2015, a total of 29 states have established Medicaid income eligibility levels for adults, including parents, at or below this income level to directly reflect the states’ active adoption of the Affordable Care Act (ACA) Medicaid expansion. Upon the ACA’s implementation, Medicaid eligibility was expanded to low-income adults. Two expansion states extended Medicaid eligibility for adults/parents above the ACA minimum levels, confirms KFF – DC at 221 percent FPL for those classified as “other adults” and CT at 201 percent for parents.

    The role of Medicaid for economically disadvantaged adults has increased within these 29 states that have formerly adopted Medicaid expansion, KFF additionally confirms.

    States KFF, “Although full federal financing for the expansion begins to phase down in 2016 to 90%, there is no deadline by which states must adopt the Medicaid expansion to low-income adults and debate continues in several states.” KFF adds gaps in coverage will occur for those states that have not yet adopted the Medicaid expansion.

    Concerns and praise for HELP Act

    Healthcare industry leaders and experts cite both firm benefits and disadvantages of the aforementioned initiatives.

    Expansion will boost the economy and create 12,000 additional jobs, according to the Bureau of Business and Economic Research (BBER) with The University of Montana.

    The financial benefits of the HELP Act’s acceptance of federal funds are widespread, according to BBER. “New federal dollars will flow into Montana as the federal government supports each state’s Medicaid expansion,” maintains BBER. “These dollars otherwise wouldn’t exist, and as such, new dollars create jobs, labor income, and potential new tax revenues for state governments,” BBER adds.

    However, low-income Montana families may be unable to easily afford their healthcare premiums. Says The Montana Budget and Policy Center (MPBC), “While the premiums will be limited to 2% of enrollees’ modified adjusted gross income, this could be a real stretch for Montana’s low-income families.”

    A failure of premium payment is perhaps likely for those Montana residents who earn below 100 percent of the poverty line, confirms MPBC. “There is no disenrollment for nonpayment, however the unpaid premiums become a collectable debt by the state,” adds MBPC. “For Montanans who are above 100% of the poverty line, failure to pay within 90 days of notice will result in disenrollment.”

    Adds MBPC in reference to those 70,000 Montanans affected by the bill's passing, “This is too important.”

    Although the widespread influence of the Montana HELP Act is perhaps yet to be firmly determined, it is hopeful any of the aforementioned wrinkles will be ironed out so the healthcare industry can prosper and thrive accordingly and low-income beneficiaries will receive improved access to high quality, value-based care.