Obamacare-enrollment.com is a site where you can find detailed information on the Affordable Care Act for individuals and small businesses.
Health Insurance Marketplace in Montana
If you live in Montana, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Montana
In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.1 The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed in the Affordable Care Act of 2010. Governor Brian Schweitzer (D) vetoed SB 228 on April 13, 2011.4 Later in April, the legislature issued HJR 33, a joint resolution to allow the Economic Affairs Interim Committee to study the implications, options, and repercussions of a state-based health insurance exchange.5
Also in April 2011, the Governor vetoed SB 176, which would have prohibited qualified health plans participating in a health insurance exchange in Montana from covering abortions, except in cases of life endangerment or severe health impairment of the pregnant woman.6
Contracting with Plans: On February 26, 2013, Commissioner Lindeen sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Office of the Commissioner of Securities and Insurance (CSI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). CSI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. CSI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.7
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Montana has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Montana- Blue Dimensions.
Consumer Operated and Oriented Plan Program
Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets. CO-OP’s in Montana:
The Montana State Auditor received a federal Exchange Planning grant of $1 million in 2010.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Montana is not participating in Medicaid expansion.
On March 8, 2013, Montana received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.8
1. Dennison, M. “Lindeen: Feds Will Have Health Insurance Exchange Up Next Year.” Billings Gazette. December 10, 2012. http://billingsgazette.com/news/state-and-regional/montana/lindeen-feds-will-have-health-insurance-exchange-up-next-year/article_bc8af918-c068-5d0b-a62c-78879352a66a.html
2. HB 620. Montana bill to generally revise health care law to create health care gateway. 2011.http://data.opi.mt.gov/bills/2011/billpdf/HB0620.pdf
3. HB 124. Montana bill to create a state-level health insurance exchange. 2011.http://data.opi.mt.gov/bills/2011/billpdf/HB0124.pdf
4. SB 228. Montana act prohibiting creation of a state-based health insurance exchange under the Patient Protection and Affordable Care Act. 2011. http://data.opi.mt.gov/bills/2011/billpdf/SB0228.pdf
5. HJ 33. Montana’s joint resolution for an interim study of a health insurance exchange.http://data.opi.mt.gov/bills/2011/billpdf/HJ0033.pdf
6. SB176. Montana’s 2011 act to prohibit plans in the exchange from covering abortion.http://data.opi.mt.gov/bills/2011/billpdf/SB0176.pdf
7. Letter from Commissioner Lindeen to Gary Cohen. February 26, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/mt-exchange-letter-2-26-2013.pdf
8. Letter from Gary Cohen to Commissioner Lindeen. March 8. 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/mt-pm-letter-3-8-2013.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation
Who can help you (the Navigators)
Planned Parenthood of Montana (PPMT) will use funds to establish the Montana Marketplace Connection to assist consumers in navigating the Montana Marketplace. Consumers will be able to access assistance from a Navigator by scheduling an appointment or as a walk-in to a PPMT health center, calling a hotline or by video conferencing.
The Montana Primary Care Association (MPCA) is an association of community health centers aimed at delivering primary and preventive healthcare to under-served and vulnerable populations. MPCA will use funds to partner with 17 affiliated federally-qualified community health centers, which provide primary and preventive health care services to 100,000 Montanans in 20 counties, to serve currently uninsured Montanans. Funding will be used to train community health center staff to expand current outreach and enrollment assistance activities and to enroll patients into affordable health insurance coverage.
Rural Health Development is a non-profit consortium of rural health care providers established in 1990 with a strong network of relationships enabling them to bring value to healthcare through cost savings, research and development of products and services in underserved Frontier communities. Rural Health Development will provide enrollment assistance, through member health care providers, in eastern Montana.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know at obamacare-enrollment.com and we’ll get right back to you.