The Obama administration has concerns about provisions in Montana's new law to expand Medicaid, but it is willing to work with the state to overcome them, a spokesman for HHS said on Friday.
Agency spokesman Ben Wakana said in a statement that officials are encouraged by the bipartisan support of Medicaid expansion and look forward to working with the state on a few concerning issues. "As we consider the state's proposal, our priority will be to make sure that any waiver approval provides for coverage that is affordable and accessible for Montanans and does not impose significant cost-sharing or premiums on individuals with very low incomes," Wakana said.
The federal officials are concerned about Montana's proposal to require that people earning as low as 50 percent of the federal poverty level, close to $6,000 per year, pay monthly premiums and that it proposes what they called significant cost-sharing on top of those premium payments.
Gov. Steve Bullock signed the Medicaid expansion bill into law on Wednesday. Sponsored by Republican Sen. Ed Buttrey of Great Falls, the new law would accept federal funds to expand Medicaid eligibility to people with incomes at or below 138 percent of the federal poverty level, about $16,200 per year for an individual and $33,460 for a family of four.
Unlike straight Medicaid expansion, it would require people who enroll to pay health care premiums that amount to 2 percent of their income as well as copays.
Enrollees also would be asked by the state Department of Labor to participate in a workplace assessment survey in order to create a job placement plan that could include job training. Buttrey has said that helping people find jobs or better-paying work could give them a pathway out of poverty.
He also estimates that partially because of the costs, about 45,000 of the 70,000 Montanans eligible would enroll in the program in the next few years.
Additionally, because of the added stipulations, the state must seek a waiver from the federal government before the program can be implemented. Other states, including Indiana, have received waivers and approval for their Medicaid expansion plans.
Buttrey said Wednesday that he had been involved in talks with the Obama administration for months about the added provisions and said the state would be pushing the federal government further than other states have done so far.
The state will draft the waiver plan and allow for a two-month online comment period before sending it to the federal government for review. An Obama administration official said Friday they are committed to supporting state flexibility and working with Montana on solutions that are consistent with federal law.
As originally enacted, the Affordable Care Act required states to expand Medicaid to adults earning up to 138 percent of the federal poverty level. A U.S. Supreme Court decision in 2012 made the expansion optional for states. In 2013, a Montana measure to expand Medicaid died by one miscast vote.