Common Questions Answered

Montana Medicaid: Frequently Asked Questions

The 2015 Legislature has the opportunity to improve the health status of thousands of Montanans and take meaningful steps toward controlling health care costs by providing health insurance coverage to low-income adults.

Q – What low-income populations are currently eligible for Medicaid in Montana?

A – Families with dependent children, pregnant women, women diagnosed with breast or cervical cancer, adults over the age of 65, and people with certain disabilities may be eligible for Medicaid coverage. Children between the ages of 0-18 may be eligible for the Healthy Montana Kids program (which provides Medicaid benefits).

Q – How many Montanans could be eligible for Medicaid if Montana provided health insurance coverage to adults earning less than $16,105 a year (138 percent of the Federal Poverty Level)?

A – An estimated 70,000 adults would become eligible for coverage if Montana expanded Medicaid. Many of these Montanans earn less than 100% of the Federal Poverty Level ($11,490 a year), and are not eligible for subsidies to help them afford commercial coverage in the new health insurance marketplace.

Q – Who can receive tax credits and subsidies under the Affordable Care Act (ACA)?

A – Individuals with incomes between 100 percent of the Federal Poverty Level ($19,790 annually for a family of three), and 400 percent of the Federal Poverty Level ($79,160 annually for a family of three). Individuals with incomes below 100 percent of the Federal Poverty Level are not eligible for these tax credits or subsidies.

Q – What percentage of costs will the federal government pay for the newly eligible Medicaid population?

A – Under the current law, the federal government will pay 100 percent of the cost of the newly eligible population until 2017, and no less than 90 percent of the cost after that. The federal government pays about 66 percent of the cost of the traditional Medicaid program.

Q – How much federal money is Montana losing by not expanding Medicaid?

A – In 2013, the state estimated that expanding Medicaid could bring more than $2.1 billion federal dollars into Montana by 2017. Of that amount, Montana has already forfeited more than $421 million by not expanding Medicaid. Source: State Budget Office, 2013 Legislative Fiscal Note, SB395

Q – I’ve been told Montana is already financially contributing to Medicaid expansion. How is that possible?

A – Federal law requires Medicare and Medicaid payments to Montana hospitals to be reduced by $400 million over the next 10 years to offset the costs of coverage expansion. These payment cuts began in October 2010, which means our local dollars are already being spent to pay for Medicaid expansion in other states – and Montanans aren’t receiving any of the benefits.

Q – Will Medicaid expansion benefit Montanans who already have health insurance?

A – Yes. Increasing the number of Montanans with health insurance will reduce uncompensated care provided by hospitals and other health care providers. Hospitals cannot absorb the cost of uncompensated care (which totaled about $400 million in 2013), so these costs are passed on to privately-insured individuals. This contributes to the rising cost of health care and increased health insurance premiums for individuals and businesses.

Q – Will Medicaid expansion benefit the state of Montana?

A – Yes. Providing health insurance to more low-income Montanans will increase the value of our tax dollars, curb wasteful spending and reduce the overall cost of health care. People covered by health insurance are more likely to obtain routine and preventive care, which leads to a healthier and more productive population.