Montana

Section 1115 Waiver – In January 2004, the Centers for Medicare and Medicaid Services (CMS) approved a Medicaid Section 1115 waiver that would allow Montana to provide a limited Medicaid benefit package of optional services for Medicaid-eligible parents aged 21 through 64 who are not pregnant or disabled. The optional services were excluded to align coverage with typical employer-sponsored insurance. This waiver was based on a previous Montana waiver, which provided a limited Medicaid benefit package to adults who are neither disabled nor pregnant, under the authority of Montana’s welfare reform waiver in 1996.

In 1987, the Montana Comprehensive Health Insurance Association (MCHA) began operation. The pool operates a traditional high-risk pool for Montana residents who received rejection from health plans for health coverage, have a qualifying medical condition, or received a restrictive rider or pre-existing condition exclusion. The Montana Comprehensive Health Insurance Association also serves as a HIPAA alternative mechanism that guarantees coverage for individuals who lose access to group coverage and provides coverage for specific federally eligible individuals.

MCHA operates a premium assistance pilot program designed to assist low-income individuals with purchasing coverage. The program, funded with a federal grant, reduces the preexisting condition waiting period to four months (if applicable) and subsidizes premiums 45 percent. MCHA enrollment as of June 2006 was approximately 3,200.

In 2003, the Montana legislature passed HB 384 which allows for limited-benefit plans to be available to those who purchase health insurance in the individual market as long as they are notified which services are not covered and have been uninsured for 90 days or more. Inpatient services are not covered in these plans. Insurers may also limit coverage for newborns, severe mental illness, emergency services, certain basic health services, and services provided by a certain category of licensed health care practitioners. Limited-benefit plans may be renewed for additional 12-month periods for up to five years, effective until 2009.

SB 419 defines adults up to age 25 as dependents for the purposes of health coverage as long as they are not married and not eligible for employer-sponsored coverage that has a same or lower premium as that available through their parents’ plan.

In 2005, the Small Business Health Care Affordability Act was approved, allowing small businesses (2-9 employees) in Montana to join a purchasing pool to obtain health insurance. Now called Insure Montana, the program provides tax credits to small businesses that are currently offering health insurance and provides premium assistance for small employers that begin to offer insurance through the State Health Insurance Purchasing Pool or a qualified association plan. The program is funded by a tobacco tax. During the fall of 2006, enrollment in the program was approximately 2200 lives (360 firms).

State Profiles