1. Montana Medicaid expansion and the help plan
October 11, 2016
Presented by jade Atkinson & Rebecca corbett

2. Renewals
As of January 01, 2016, the State has an automated renewal process.
CHIMES EA identifies all ACA benefit recipients – standard Medicaid and HELP – that are due for Renewal and verifies those which are reasonably compatible with regard to Demographic and Income information.
This is completed using our electronic data sources
If all demographic and income information are compatible (within 10%), the individual’s benefits are renewed and a notice is sent.
If the person cannot be automatically renewed, the individual will be sent a renewal form. The form does not need to be returned, but new information must but sent in to the State along with a signature. The signature can be verbal, electronic, or hand written.
Renewals can be completed by mailing or faxing in the information, online at apply.mt.gov, in person, or over the phone by calling the Public Assistance Help Line at
The renewal form does not include information about available assistance from enrollment assisters. The renewal form is for all Medicaid programs and not specific to ACA programs.

3. Continuous Eligibility
For all ACA health coverage programs, there is a 12 month continuous eligibility span. This means changes in income and filing units will not affect the individual’s eligibility unless they request a recalculation of their premium or maximum out of pocket expense.
There are eight circumstances where an individual’s health coverage may be terminated during the span:
No longer a Montana resident
Requests termination of benefits
Individual dies
Failure to provide or obtain a Social Security Number
Individual provides an incorrect or fraudulent Social Security Number
Failure to provide citizenship or immigration status documentation
Individual found ineligible during Post Eligibility Verification process or Medicaid was determined in error
Individual cannot be located

4. INcome
Income is countable towards all other individuals that are included in the income earner’s filing unit.
Example: Household is boyfriend, girlfriend, and their child in common; they file separately since they are not married and girlfriend claims the child as a dependent and all are applying for health coverage. Income will count towards boyfriend’s and child in common’s eligibility.
Look back period = retro coverage
Income for any retro month is counted in full – we use all income received in the retro month to determine eligibility
Example: application received 10/01/2016 and individual lost their job on 09/16/2016 and final check was received 09/30/ For 10/2016 and ongoing we would not use any income to determine eligibility, but for retro months of July, August, and September we would use all income the individual received in those months.
Individuals determined ineligible at application or renewal due to being over the income standard are electronically transferred to the Federal Marketplace in a nightly batch process. There should be no gap in coverage for the individual and the data transfer process from the State to the Marketplace has been working smoothly.

5. Disenrollment
If an individual on the HELP TPA program hasn’t paid his/her premium for 90 days or more, s/he will be disenrolled from services at the 120 day point.
Blue Cross Blue Shield of Montana will transfer the individual’s past due premiums and send them to the State (DPHHS). If the past due/delinquent premiums aren’t paid by the end of the quarter, they will be transferred to the Department of Revenue for tax offset.
CHIMES EA will evaluate the individual for exemptions and will not disenroll the individual if they have an income less than 100% FPL or meet two exemptions. The individual still owes the past due/delinquent premiums, but remains eligible for services.
The individual remains eligible for HELP TPA and will show as eligible in CHIMES EA, however, s/he will show as inactive to providers.
Once the individual pays the past due/delinquent premiums or they are transferred to Department of Revenue, the individual is eligible for re-enrollment. The individual must opt-in to re-enroll.
Can re-enroll online at apply.mt.gov, via an automated phone line at , or by calling the Health Coverage Unit at option 5.

6. Exemptions from disenrollment
Individuals can be exempt from disenrollment if:
Individual’s MAGI income is less the 100% FPL
OR two of the following:
Individual was discharged form the U.S. military in the last 12 months
Individual is enrolled for credit in any Montana university system, tribal college, or any other accredited college within Montana offering at least an associate degree.
Can only use this exemption for 4 years
Individual sees a primary care provider who is part of a patient-centered medical home
Individual is in a substance use treatment program
Individual is participating in the Department of Labor workforce program
Individual is participating in the third party administrator (TPA) sponsored wellness program

7. Health Coverage unit
The Health Coverage Unit is a unit of four Health Coverage Coordinators that work with more specialized programs.
Presumptive Eligibility
Breast and Cervical Cancer Treatment
Subsidized Adoption
Department of Corrections and Pre-Release
Disenrollment & Re-enrollment of the HELP TPA program
Please call the Public Assistance Helpline at and press option 5 to get in touch with someone from the Health Coverage Unit.

8. By Percent of County Population
HELP Program Newly Enrolled By County (as of September 1, 2016)
Total Newly Enrolled: 52,817
By Percent of County Population

9. MEDICAID EXPANSION Standard Medicaid Administered by Xerox HELP Plan
Adults, ages 19-64
Incomes 0-138% FPL
Montana residents
US citizen or documented, qualified alien
Not incarcerated
Not eligible or enrolled in Medicare
Standard Medicaid
Administered by Xerox
Individuals under 50% FPL
Individuals determined to be medically frail
American Indians/Alaska Natives
Individuals who live in a geographical area with insufficient health care providers
Individuals in need of continuity of care that would not be available or cost-effective through the TPA
Not subject to premiums
Subject to copayments
Unless exempt by federal law
HELP Plan
Administered by Blue Cross and Blue Shield of Montana
Individuals with % FPL
Subject to copayments and premiums
Unless exempt by federal law

10. Help plan benefits Services Processed by BCBSMT
Behavioral Health (Mental Health and Substance Use Disorder)
Convalescent Home (excludes Custodial Care)
Durable Medical Equipment/Supplies
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Emergency
Hospital
Lab and X-Ray (Medical)
Medical Vision and Exams
Mid-Level
Physician
Rehabilitative and Habilitative
Surgical
Therapies (OT, PT, ST)
Urgent Care

11. Help plan benefits
Services Processed by Xerox
Audiology
Dental and Dentures
Diabetes Prevention Program
Eyeglasses
Federally Qualified Health Center
Hearing Aids
Home Infusion
Indian Health Service/Tribal Health
Pharmacy
Rural Health Clinic
Transportation
Remember: The participant will have a BCBSMT HELP Plan card, but these claims are processed by Xerox.

12. Standard Medicaid benefits
All Services are Processed by Xerox
Audiology
Behavioral Health Services
Clinic Services
Dental Services
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Federally Qualified Health Clinic
Hospital Services
Immunizations
Indian Health Service/Tribal Health Service
Lab and X-Ray Services
Nurse First Services
Nursing Homes
Occupational Therapy
Pharmacy
Physician
Rural Health Clinic
Tobacco Cessation
Transportation
Vision

13. HELP Healthy behavior plan
Wellness Programs in the Healthy Behavior Plan
Community Based Wellness Programs (DPHHS)
Montana Living Life Well Program
Diabetes Self-Management Education
Arthritis Foundation Exercise Program
Walk with Ease Program
Diabetes Prevention Program
Montana Tobacco Quit Line
BCBSMT Wellness Programs
Asthma Management Program
Diabetes Prevention and Management
Hypertension
Tobacco/Smoking Cessation
Weight Loss and Healthy Lifestyle
Individualized Programs
Participants may call BCBSMT Participant Services (877) to enroll or learn more about this benefit. Descriptions of these programs are available on the BCBSMT participant portal, and DPHHS Community Based Program page.

14. Contacts and resources
Jade Atkinson
ACA Policy Specialist
Christie Twardoski
Associate Administrator,
Human & Community Services Division
Rebecca Corbett
HELP Program Officer
Renae Huffman
Office of Public Assistance
Helpline:
Blue Cross and Blue Shield of Montana
Participant Services:
Provider Services:
Xerox
Member Services:
Provider Relations: