Medicaid, SCHIP, and Federal Authority³

Section 1115 Waiver - In January 2004, 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 - 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.

Limited-Benefit Plan

In 2003, the Montana legislature passed HB 384 which allowed 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 remained 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. Demonstrations may be renewed for additional 12-month periods for up to five years, effective until 2009.

High-Risk Pool

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 to purchase coverage. The program reduces the preexisting condition waiting period to four months (if applicable) and subsidizes premiums 45 percent and is paid for with a federal grant. MCHA enrollment as of June 2006 was approximately 3,200.

Group Purchasing Arrangement 

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).

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

⁴ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.