It took three years and a compromise bill at the state Legislature, but on Nov. 2 Montana officially became the 30th state in the country to expand its Medicaid program under the Affordable Care Act.
This means tens of thousands of Montanans have the option to sign up for health care insurance coverage, now that the eligibility requirements have been expanded to include everyone at or below 138 percent of the federal poverty level.
Currently, the federal poverty level is $11,770 for a single person, and $24,250 for a family of four. Under the expansion, single people making about $16,000 would be eligible for Medicaid, and a family of four could earn about $33,000.
Medicaid expansion was a key part of the ACA, but in 2012, the U.S. Supreme Court made it optional for states to participate in widening the percentage above the poverty level for eligibility.
November also marked the start of open enrollment for the Health Insurance Marketplace. Finding the right kind of health insurance, or even what health insurance one might qualify for, can be confusing, Andrea Cheroske of the Flathead City-County Health Department said, but there is help available.
Certified application counselors such as Cheroske are on hand at the Kalispell office to help shepherd people through the application process, for either open enrollment or Medicaid.
“People can come to us for assistance with applying for and enrolling for insurance through the healthcare marketplace,” Cheroske said. “They can also call us if they have any questions if they’re going through the process themselves.”
The application counselors at the health department would typically help guide an applicant through the Healthcare.gov website, Cheroske said, because the process is the same for that and for Medicaid – both are income-based, and the applicant would find out if they are eligible for tax credits or for Medicaid coverage.
Cheroske also said anyone who is re-enrolling in the marketplace or who received notification of their insurance premiums increasing and have questions can also call for navigation help.
“If it’s insurance related and they’re not sure where to go, then they can come to us,” she said. “It is a really good service. It’s free and we’re not affiliated with any insurance company so it’s unbiased help for whoever needs it.”
The health insurance assistance crew at the health department can be contacted at (406) 758-2165, and the department’s website is available at www.flatheadhealth.org.
Applicants can also check www.apply.mt.gov or www.healthcare.gov to start the process themselves.
The health department and Kalispell Regional Medical Center will host an event to help people sign up for insurance on Saturday, Nov. 14 at KRMC’s east/west dietary conference room.
According to Gov. Steve Bullock’s office, Medicaid expansion means an additional 70,000 people in Montana are eligible for health insurance coverage, though legislative fiscal analysts predict about 45,700 would participate in the next four years.
The state Legislature passed a compromise bill on Medicaid in the 2015 session, including aspects like the state needing a waive by the federal government for certain changes such as charging premiums and outsourcing the program’s administration to Blue Cross and Blue Shield of Montana.
The plan also requires patients to make the maximum copayments allowed under federal law, which, when combined with premium payments, cannot exceed 5 percent of a household’s income.
Also, people with incomes above the federal poverty line who don’t pay their premiums will be dropped from the program. The governor’s office said those who fall under the poverty line won’t be kicked out if they don’t pay, but those non-payments become a debt to the state that can be collected later. Some people, including Native American reservation populations and the medically frail, will be exempt from the requirements.