Montana Could Face Tough Bargaining With Federal Officials On Medicaid Expansion Plan

Montana’s blueprint for expanding Medicaid on terms that are palatable to the fragile bipartisan legislative majority that passed an expansion law earlier this year has been released for public comment before it is formally submitted to federal officials.

A leading expert on Medicaid waivers, however, says Montana is unlikely to get exactly what it wants.

“A waiver proposal never comes out the way that it went in,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “All of these waiver negotiations require some flexibility on both sides.”

Montana is the only state to say yes to Medicaid expansion this year. If its plan is accepted by the federal Centers for Medicare and Medicaid Services (CMS), it will join 28 other states and the District of Columbia in accepting the health law’s federal funding to expand the joint federal-state health care program to anyone with an income below 138 percent of the federal poverty level.

But the Montana plan doesn’t offer the coverage free. Instead it would require all recipients who come into the program through the expansion to pay a premium of up to 2 percent of their income in order to receive benefits.