The Montana HELP Act: A New Pathway to Insure 70,000 Montanans

If you’ve been following our blog, you know that the Montana Budget and Policy Center unequivocally supports expanding Medicaid coverage in Montana. Providing affordable health care coverage to up to 70,000 Montanans who are without access right now not only improves these folks’ lives, but will also inject nearly $5 billion in federal funds into Montana’s economy. Expansion will create 12,000 jobs and it will reduce uncompensated health care costs the state.

While dozens of states have implemented straightforward Medicaid expansion, other states have taken a different approach. We know that the state legislature will need to find a compromise to pass legislation through both the Montana House and Senate. This is why we supported the Healthy Montana Plan HB249. Even though that bill failed, we still continue to push for legislation that accepts the federal funds available and expands access to the 70,000 Montanans who need it.

This week, Senator Ed Buttery introduced the Montana HELP Act (SB 405), and we believe it is a promising step forward to expanding Medicaid in Montana. This compromise legislation has bipartisan support from both chambers. It accepts federal funds, which will inject hundreds of millions of dollars into Montana’s economy. It will also provide access to affordable health care to the entire population who need it. We know how important it is to pass a policy in Montana before the legislature adjourns and this is why we will testify in support of SB405.

However, as part of any compromise, there are concerns regarding provisions of this bill. The HELP Act will charge new enrollees a premium for access to health care coverage. 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. Additionally, the bill requires new enrollees to pay co-pays for certain services (up to another 3% of their modified adjusted gross income). This cost sharing can add up to 5% of their modified adjusted gross income – that is the maximum allowed under federal law. The good news is that co-pays will not be applied to preventative health care, health screenings, immunizations, or generic pharmaceuticals for chronic medical conditions.

Another concern is the penalties for failure to pay premiums. For Montanans who are below 100% of the poverty line ($11,770 for an individual or $20,090 for a family of three), there is no disenrollment for nonpayment, however the unpaid premiums become a collectable debt by the state. For Montanans who are above 100% of the poverty line, failure to pay within 90 days of notice will result in disenrollment. They can be reenrolled upon payment.

Lastly, there is an asset based fee provision. However, it only applies to people who have assets in excess of: (1) $250,000 of equity in a primary residence, (2) a primary vehicle, and (3) $50,000 in additional cash or cash-equivalent assets.

Even with our concerns about the additional hurdles SB 405 places on low-income families, we will support this legislation and we hope policymakers will seriously consider this compromise. We’ve been saying it for over a year now – 70,000 can’t wait. We cannot ask our fellow Montanans to continue to wait for health care. This is too important.

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