Montana's Medicaid proposal may face scrutiny from CMS

Montana, the only state to agree to expand Medicaid this year, has released its proposal for public comment before its submission to federal officials. But it's unlikely the state will get exactly what it wants, reports Kaiser Health News.

The plan does not offer free health insurance. Rather, it requires beneficiaries to contribute up to 2 percent of their incomes to pay a monthly premium.

"Premiums are not permitted in the Medicaid program, and a state definitely needs a waiver to move forward with any premium proposal," Joan Alker, executive director of the Center for Children and Families at Georgetown University, tells KHN.

The provision raises red flags for the Centers for Medicare & Medicaid Services. Recently, CMS gave the go-ahead to waivers in Indiana and Iowa that prevent premiums for individuals below 100 percent of the federal poverty level. But in both states, those below that level cannot be disenrolled for failing to pay the fees.

But Alker tells KHN that CMS is willing to approve premiums of 2 percent of income because studies show that "premiums for very low income people deters enrollment, and creates a barrier to coverage that we know will result in many people not getting coverage."

Montana has given the public 60 days to comment and is hopeful it can finalize waiver terms in time for open enrollment that begins in November, KHN adds.

Now that the Supreme Court's King v. Burwell decision is in the past, President Barack Obama has said he will focus on convincing more governors and state legislators to take advantage of the Affordable Care Act and to expand Medicaid. One reason many Republican leaders are more open to expansion talks is because of generous financial aid, FierceHealthPayer previously reported.  

For more:
- here's the KHN piece
- here's where the public can comment (.pdf)