MTPR

Billings Crowd Urges Approval Of Montana Medicaid Expansion Waivers

Aug 19, 2015

Nearly 80 people turned out for a public meeting in Billings Tuesday afternoon on the state of Montana’s proposed waiver request for its Medicaid expansion program.

As Jackie Yamanaka reports, all of the two dozen people who offered comments want the Centers for Medicare and Medicaid Services to approve Montana’s two waivers.

One waiver asks CMS to allow Montana to hire a third-party-administrator (TPA) to run the program. If federal officials give the OK, Montana would become the only state in the nation to use a TPA in its Medicaid expansion program.

J.J. Carmody is director of reimbursement for Billings Clinic. She says the provider supports using a TPA, noting that model has worked well for Healthy Montana Kids, the CHIP program.

"We just want to point out the commercial insurance can sometimes be difficult to understand and cumbersome to implement and we want to encourage the Department to facilitate an environment where the TPA can work closely with providers in designing a system that is easy to understand and implement for all parties, especially those newly enrolled."

Carmody adds Billings Clinic approves of the streamlined application program that will allow health providers to verify coverage in a timely manner. She says the traditional Medicaid program still lags in showing eligibility.

"So we’re very excited about the state’s application for a fast track, express lane eligibility waiver that allows for that continuous eligibility."

She was just one of nearly two dozen people to comment on the state’s version of Medicaid expansion known as the HELP Act. It seeks to provide health insurance coverage to Montanans who earn too much to qualify for traditional Medicaid but not enough to buy insurance through the Affordable Care Act.

Those covered by Medicaid expansion will have a variety of services covered, including preventative screens, dental, eye glasses, and audiology.

The other waiver Montana is seeking would require most of those covered under the HELP Act to have premiums and co-pays.

Martha Stahl is president and CEO of Planned Parenthood of Montana. She supports the state’s proposal that would not require a co-pay for preventative services.

"But the waiver doesn’t clearly define preventive services," Stahl says. "It does specify no co-payments to services that are legally exempt. Under federal law, family planning and pregnancy related care are exempt and we just urge that the waiver explicitly clarify that."

Those covered by the HELP Act are not allowed under the TPA to seek medical care outside of the designated network. But Stahl thinks participants should be allowed to go to Planned Parenthood of Montana, for example, for family planning services even if the provider is not part of the TPA’s network.

This was the first public listening session Department of Public Health and Human Services officials plan to hold before submitting the waivers to CMS September 15.

The next session is Thursday in Helena. Comments can also be submitted online, or in writing.