Senate Bill 405, which would expand Medicaid to cover thousands of low-income adults in Montana, is a complex, multifaceted bill. Here’s a summary of its main elements:
• Expanded Medicaid eligibility: Adults up to age 64 earning up to 138 percent of the federal poverty level (about $16,200 for a single person, $27,700 for a family of three) will be eligible for coverage.
• Effective date: If federal health officials approve the plan, later this year. It’s possible the expanded coverage could start next January.
• Enrollment and federal funding: It’s estimated the 27,000 to 45,000 Montanans would sign up for coverage in the next four years. If those estimates are accurate, $1 billion in federal funding would flow into the state over that time period and the state would pay about $6 million.
The federal government covers the entire cost of the program in 2016 and reduces it gradually the next four years, down to 90 percent.
• Coverage: Medicaid covers basic medical and dental care, including physician visits, hospital visits, mental health and other services.
• Premiums: 2 percent of a person’s or family’s annual income.
• Personal asset limits: Participants in the plan can own a “primary residence” and one light vehicle and have up to $50,000 in cash resources. However, if their assets exceed these limits, they must pay an additional fee of $100 per month and an additional $4 a month for each $1,000 in assets over the maximum allowed amount.
• Workforce development: Those covered by the program can get an “employment or re-employment assessment” from the state Department of Labor to help them get work or a better job. Its participation is voluntary.
• Medical malpractice liability reforms: Reduces from three to two years the amount of time someone has to file a claim of medical malpractice after the injury.
• Medicaid program reforms: The bill directs the state to start pilot programs and take other steps to encourage less use of high-cost health care and reduce fraud and abuse within the program.
• Third-party administrator: Directs the state to hire a “third party administrator,” which is usually a health-insurance company, to administer the payments and collection of premiums within the program.
• Oversight committee: Creates an 11-member committee appointed by legislative leaders and the governor to oversee and advise on the expansion.