Obama officials express 'concerns'

HELENA - The Obama administration Friday said it has some "concerns" about provisions of Montana's plan to expand Medicaid, such as charging premiums to those with very low incomes, but will work closely with state officials to review the plan.

"Our priority will be to make sure any ... approval provides for coverage that is affordable and accessible for Montanans and does not impose significant cost-sharing or premiums on individuals with very low incomes," said Ben Wakana, spokesman for the U.S. Health and Human Services Department in Washington, D.C.

Friday's comments are the first public statements by the Obama administration on Montana's plan to expand Medicaid under the Affordable Care Act, extending government-funded health coverage to thousands of low-income Montanans.

The 2015 Legislature approved the bill to expand Medicaid two weeks ago and Gov. Steve Bullock signed the bill into law Wednesday. Once the plan is up and running, it's estimated Montana could receive at least $400 million in federal funds to finance the expanded coverage the next two years.

However, because Montana's plan has some unique requirements not seen in other states, it must get a "waiver" from the federal government, which is funding 100 percent of the expansion through 2016.

The feds' share then gradually ramps down to 90 percent by 2020, with Montana picking up the cost for the remainder of the expansion.

State health officials said earlier this week they'll prepare the waiver application and submit it to HHS later this year.

The expansion extends Medicaid health coverage to all able-bodied adults earning up to 138 percent of the federal poverty line, about $16,200 for a single person. The eligibility income ceiling increases according to family size.

Under Montana's program, those eligible for the plan must pay a premium equal to 2 percent of their income. They also must pay higher fees if their financial resources exceed certain amounts.

Obama administration officials said Friday they are "concerned" that the state plans to charge premiums even to people earning below 50 percent of the federal poverty line (about $5,900 a year for a single person) and that the plan has other "cost-sharing" requirements for those covered.

The administration is "committed to supporting state flexibility and working with states on solutions that are consistent with federal law, and our priority is ensuring affordability and access," they said.

Wakana also said the administration is appreciative of "the governor's ongoing leadership" and is "encouraged by Montana's bipartisan support of Medicaid expansion that would provide coverage for 70,000 low-income Montanans."

The plan was approved by the Legislature by a coalition of Democratic and Republican legislators, although most Republicans voted against it.

The Bullock administration has estimated that only 30,000 Montanans would sign up for the plan in its first two years.

Once the state prepares its waiver application, the public will have two months to comment before the application is sent to the federal government for review.

Montana's plan also requires the hiring of a private insurance company to manage it, and the contractor must be hired through a bidding process before people can start signing up.