- What is Medicaid?
- Did Montana expand their Medicaid program?
- Am I eligible for Medicaid in Montana?
- How do I apply for Medicaid in Montana?
- What mandatory benefits does Medicaid cover in Montana?
- What is the difference between Medicaid and Medicare?
Medicaid is a government program that provides health insurance coverage to low-income Americans. As a result of this federal-state partnership, 1 in 5 Americans are able to access health insurance through Medicaid. This insurance program covers a wide-range of healthcare services, while also enforcing out-of-pocket limits that keep healthcare affordable.
Medicaid eligibility is determined based on income level, and different states have different eligibility guidelines depending on whether or not they expanded their programs as a result of the Affordable Care Act.
Adults, children, pregnant people, the elderly, and people with disabilities all can become Medicaid recipients.
State Medicaid programs have different names. In Montana, the Medicaid program is called Medicaid
CHIP, or the Children’s Health Insurance Program, provides low-cost health insurance to children up to age 19 whose families earn too much to qualify for Medicaid in their state but do not earn enough to be able to afford private insurance. In some places, CHIP also covers pregnant people. Every state runs and offers a CHIP insurance program for children.
In Montana, CHIP is known as Healthy Montana Kids
Yes, Montana did expand their Medicaid program. This means that as a result of the Affordable Care Act (ACA), Montana allows for nearly all low-income individuals with incomes at or below 138% of the federal poverty level (or, $17,236 for an individual in 2019) to qualify for Medicaid.
Medicaid expansion was a key part of the original version of the Affordable Care Act (ACA). Per the funding plan for Medicaid expansion outlined in the ACA, by 2020, the federal government will cover 90% of the cost of Medicaid expansion.
After a legal challenge to the benchmark Obama administration health care law, the Supreme Court ultimately decided that each state had the right as to whether they wanted to expand Medicaid or not.
States that expanded Medicaid have seen a decline in their uninsured rates. Research has also shown that Medicaid expansion made health care more accessible and more affordable to people. As a result, people in states with Medicaid expansion also saw better health outcomes. Medicaid expansion also has been good for tax payers, who are footing fewer unpaid bills for care low-income people cannot afford. It has been good for the economy and job market too.
Federal law requires that states provide certain groups of individuals with Medicaid health insurance coverage. These are what’s known as mandatory eligibility groups, and they include groups like low-income families and qualified pregnant people and children. States then have additional options about who else they might cover, including those receiving home- and community-based services and children in foster care who are not otherwise eligible.
The Affordable Care Act (ACA) allowed states the option of expanding their Medicaid programs to cover low-income adults. Qualification requirements and income limits for Medicaid depends on whether your state expanded Medicaid and whether you meet any other criteria (for example, if you are pregnant, are parenting a child under the age of 19, or have a disability).
Federal poverty guidelines are based on household size and are issued by the Department of Health and Human Services.
Medicaid in Montana only requires asset testing, meaning both your income and your assets are used to calculate eligibility, if you fall into one of the following groups:
- Eligible for SSI
- Over the age of 65 and make at or below 100% FPL
- Institutionalized
- Disabled
- Medically needy
- Foster care children
- Eligible for home and community-based waiver services
Applying for Medicaid is simple through HealthSherpa!
You can complete your Medicaid application online through HealthSherpa. When you do so, you will find out as soon as you complete your application if you are eligible. This is because your state has allowed the Marketplace itself to officially determine whether you qualify for Medicaid in your state. And because HealthSherpa is an official partner of the federal government and the Marketplace, completing your application through HealthSherpa will keep things streamlined and simple. If you qualify for Medicaid, once you complete your application, your state office will then send you an official letter of determination within a few weeks. However, if you don't hear from them, we always recommend giving them a call.
Once you submit your application through HealthSherpa, you will also get access to a free and secure HealthSherpa account. Here, you will be able to review suggested action items to ensure that your application process is successful. You’ll be given reminders about submitting any additional documents you might need to file with your state’s Medicaid agency to complete your Medicaid enrollment.
And once your Medicaid eligibility is approved, you will receive instructions on how to choose your new health insurance plan.
Applying for Medicaid require some basic documentation to show your income, citizenship, and place of residence.
To start, you will need a valid Social Security Number (SSN). You’ll also need proof of age. You can do this with either a birth certificate or a valid driver’s license. For proof of income, you can show paystubs, W-2 forms, or any wage and tax statementsyou may have.
If you or anyone in your family is currently enrolled in any kind of health insurance, be sure to have those policy numbers and plan names on hand too.
If you qualify for Medicaid after your apply online through HealthSherpa or HealthCare.gov, your information will automatically be sent to your state’s Medicaid agency. Your state’s own Medicaid agency will then contact you about how to enroll in Medicaid.
The Medicaid agency typically has 45 days to process your application once submitted, and up to 90 days if you believe you are eligible because of a disability. However, it may take more time than this if your state’s Medicaid agency does not have all the documentation it needs to assess your eligibility when you first apply.
If you have concerns about your application or wish to follow-up about it, you can contact your state’s Medicaid agency.
- Inpatient hospital services
- Outpatient hospital services
- EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
- Nursing Facility Services
- Home health services
- Physician services
- Rural health clinic services
- Federally qualified health center services
- Laboratory and X-ray services
- Family planning services
- Nurse Midwife services
- Certified Pediatric and Family Nurse Practitioner services
- Freestanding Birth Center services (when licensed or otherwise recognized by the state)
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
Medicaid and Medicare are both government programs that help people pay for health coverage and care, but they aren’t the same. Medicaid is for low-income people who would otherwise be completely unable to afford or access health insurance. Medicare, however, is primarily for adults over the age of 65 or younger folks with disabilities.
Medicaid is jointly funded by the federal government and each state’s own Medicaid agency. This program serves low-income people of all ages by providing health insurance at minimum cost. In doing so, it ensures that enrollees pay little to nothing for any healthcare costs they may incur. In turn, this helps some of the most economically vulnerable Americans from facing even greater financial instability by ensuring they have access to health care and that accessing health care does not create a financial strain. When it comes to Medicaid nationwide, programs and benefits can vary by state, but eligibility is generally based on income relative to a certain percentage of the Federal Poverty line.
Medicare is an insurance program mainly for people over the age of 65 of any income level, and people with certain disabilities. It is funded via a trust that enrollees pay into from the time they first enter the workforce. Once someone qualifies for Medicare, whether through age or disability, they then pay small deductibles to off-set the cost of their care. On the whole, though, this program pays for the bulk of enrollees’ medical costs out of these pre-funded trusts. As a result, health care costs are kept at a minimum for Americans as they reach the later stages of their lives. Medicare programs are essentially the same, no matter where in the United States you live.
You can apply for Medicare on HealthSherpa or by calling our Customer Advocates at (855) 930-0112 .
The HealthSherpa Consumer Advocate team is on hand to help you complete your application to see if you qualify for Medicaid, and to see if you might qualify for any other subsidies to enable you to make healthcare coverage a reality. Call us today at (855) 930-0112.
Don’t forget that you can apply for Medicaid and CHIP at any time of the year, so don’t worry about waiting until the annual Open Enrollment Period to see if you might be eligible. And if your income changes during the year, don’t hesitate to apply to see if Medicaid might be available to you.
