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Montana health insurance

CMS approves Big Sky Country’s Medicaid expansion waiver

If you live in Montana – or you’re considering moving there – you should certainly be aware of issues that impact the overall health of the state’s residents. Between a relatively high but improving percentage of uninsured and recent Medicaid expansion, there are plenty of factors that might affect your own perception of Montana’s attitudes toward providing health coverage and healthcare. We’ve put together a partial list for your consideration.

Montana health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance 2014 rated Montana 29th among the 50 states and District of Columbia. The state dropped from 20th place in 2009. Take a closer look at Montana’s Scorecard for details on how the rankings are determined.

The most recent edition of America’s Health Rankings (2014) also measured the state’s “healthiness” and ranked Montana number 22 of the 50 states—up six spots from the 2012 assessment. Montana’s ranking is helped by low rates of obesity, diabetes, and air pollution. It’s lowered by factors that include high rates of binge drinking, low immunization coverage among teenagers, and relatively few primary care physicians. Montana continues to have a large uninsured population; however, it improved from 42nd in the nation for insurance coverage in 2013 to 41st in 2014.

For more details on overall public health in Montana, check out the 2015 listing of Key Health Data About Montana, compiled by Trust for America’s Health.

Montana and the Affordable Care Act

In 2010, Montana’s U.S. Senators, Max Baucus and Jon Tester,voted to approve the health reform law. But Denny Rehberg, Montana’s sole Representative in the U.S. House, voted against the ACA. Baucus and Rehberg are no longer in Congress, but their successors – John Walsh and Steve Daines – have generally the same views as the predecessors: Walsh has expressed support for the law (although he’s also distanced himself from it, reminding constituents that he was not in the Senate in 2010 and did not vote for the law), while Daines has voted to repeal Obamacare.

At the state level, Gov. Brian Schweitzer and Insurance Commissioner Monica Lindeen were supportive of the ACA, but the state legislature was not. Two bills that would have created a state-run exchange failed in Montana in 2011, while a bill banning the creation of a state-run exchange passed. That bill (SB 228) was ultimately vetoed by Schweitzer, but in late 2012 Montana officially announced that it would default to a federally-facilitated exchange run by HHS.

How did Obamacare help Montanans?

Prior to 2014, the uninsured rate in Montana was 21.98 percent. Various studies have projected an average post-Obamacare uninsured rate of 17.65 percent, for a reduction of 4.34 percentage points. This puts Montana 34th among the 50 states and District of Columbia in terms of overall reduction in the uninsured rate.

Montana enrollment in qualified health plans

In November 2013, the Kaiser Family Foundation estimated that the potential market for Montana’s exchange was 152,000 residents and that 97,000 of them would qualify for premium subsidies to offset the cost of coverage. By the end of the 2014 open enrollment period, 36,584 people had finalized their enrollment in qualified health plans through Montana’s exchange, and HHS reported that 85 percent of them had received premium subsidies.

Three carriers are offering health insurance plans through the Montana exchange: Blue Cross Blue Shield of Montana, PacificSource, and Montana Health Co-op (newly created under the ACA).

Montana Medicaid/CHIP enrollment


In Montana, about 40,140 people – 27 percent of the state’s uninsured population – would be eligible for Medicaid if the state were to use federal funds to expand coverage under the ACA. Initially, the state did not move forward with Medicaid expansion, which meant there has not been financial assistance available for people with incomes below the poverty level who do not qualify for Medicaid under the state’s existing guidelines (Medicaid is not available in Montana for childless adults regardless of income, and is only available for parents of dependent children if their household income is under 52 percent of poverty).

Everyone else with incomes under the poverty level is in the coverage gap. As written, the ACA would have allowed all of these individuals to obtain Medicaid. But a Supreme Court ruling in 2012 allowed states to opt out of Medicaid expansion, and Montana is one of the 24 states that has not yet expanded Medicaid coverage. As a result, just 4,638 Montana residents were newly enrolled in Medicaid through the exchange by mid-April, all of them qualifying under the existing guidelines. More information on Montana’s Medicaid and CHIP coverage and eligibility is available here.

On April 29, 2015, Governor Steve Bullock signed an expansion bill into law. Because Montana’s expansion plan differs from straight Medicaid expansion, CMS must approve a waiver proposal submitted by the state. To ensure expansion effective Jan. 1, 2016, Montana requested CMS approve the plan by Nov. 1.

On November 2, CMS approved Montana’s Medicaid expansion waiver. Enrollment is now underway for coverage effective January 1, 2016.

Other ACA provisions in Montana

The Affordable Care Act established a federal loan program to encourage the creation of nonprofit, consumer-run health insurance issuers – called Consumer Operated and Oriented Plans (CO-OPs). By January of 2013, 24 CO-Ops had received loans totaling $1.98 billion, including more than $85 million for the Montana Health CO-OP, which offers coverage in both Montana and Idaho.

Medicare in Montana

Montana Medicare enrollment has typically been higher than the national average – 17.8 percent of its total population, compared with 16 percent nationwide. The state’s Medicare spending is among the lowest in the country, and its per-beneficiary spending is the lowest of all states.

Montana residents can enroll in private Medicare Advantage plans instead of Original Medicare. It is an option for consumers who seek additional benefits, and 17 percent of all Montana Medicare recipients have selected a Medicare Advantage plan instead of Original. Of all Montana Medicare enrollees, 47 percent have a stand-alone prescription drug plan.