Blue Cross out as Montana's Medicaid overseer

Montana is axing Blue Cross and Blue Shield of Montana as the overseer of its alternative Medicaid expansion program due to state budget woes. The move could lead to doctors shunning Medicaid patients, providers say.

Blue Cross and Blue Shield of Montana served as the third-party administrator overseeing the Montana Health and Economic Livelihood Partnership, or HELP, which provides Medicaid coverage to approximately 70,000 individuals who earn up to 138% of the poverty line.

The state faces a $75 million budget shortfall, and the Montana Department of Public Health and Human Services has decided to end its contract with BCBS MT, it announced in a notice being circulated to healthcare stakeholders.

Blue Cross and Blue Shield of Montana receives approximately $6 million a year for premium billing and collection, overseeing the provider network and other duties.

To make the move official, the state must submit a waiver amendment to the CMS striking all provisions in its initial application related to the program having a third-party administrator. It plans to submit the request Sept. 2, following two public hearings this month.

Under Montana's Medicaid waiver, which expires at the end of 2020, the state can charge beneficiaries up to 2% of their income for premiums, as long as the individuals earned at least 50% of the federal poverty line. Beneficiaries would lose coverage for up to three months if they failed to pay their premiums, unless they lived below the poverty level. For those individuals, the unpaid premiums would become debt that could be taken out of future state income tax returns.

John Doran, a spokesman for Blue Cross and Blue Shield of Montana said the insurer will work to ensure a smooth transition for HELP Plan participants.

A state Medicaid agency spokesman declined to comment on the matter.

The contract cancellation could affect patient access, as providers participating in the HELP program had their contracts with BCBS, not the state, and those agreements will have to be transferred.

Montana has also proposed to cut provider pay by 3.47% to address its budget woes.

"This could lead to the closure of practices to Medicaid members creating an access issue for many," said Jean Branscum CEO of the Montana Medical Association.