CMS ordered to pay Montana Health Co-op $1.2M in canceled CSR payments

Montana Health will recoup some of last year's CSR payments, but the legal battle may not be over. (Getty/LIgorko)

The Trump administration will pay Montana Health Co-op more than $1.2 million after a federal court ruled that it must make cost-sharing reduction payments to the insurer.

The United States Court of Federal Claims approved a final order (PDF) requiring the Centers for Medicare & Medicaid Services (CMS) to pay Montana Health $1.2 million it was owed for the fourth quarter of 2017, just after the Trump administration cut off Affordable Care Act payments in October of last year. 

The amount is less than a quarter of the $5.3 million the insurer said it was owed in its initial complaint. Montana Health did not dispute the calculation used by CMS.

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The judgment comes months after Montana Health won a key legal battle when Judge Elaine Kaplan ruled that the government was required to reimburse insurers based on the “the payment obligation spelled out by the plain language” of the ACA.

The decision could have ripple effects on several other cases involving CSR payments. CMS agreed to pay South Dakota-based Sanford Health Plan more than $360,000, according to a joint status report (PDF) filed in the same U.S. Court of Federal Claims.

In a recent motion (PDF) for summary judgment, attorneys for Maine Community Health Options repeatedly referenced the Montana case. The insurer says it is owed $5.6 million in CSR payments.

Montana Health’s legal battle may not be over, however. A court filing indicates the insurer can still litigate missed CSR payments for 2018 and 2019. Likewise, the Department of Justice can still appeal the federal court’s ruling.

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