Changes are Coming to Montana Medicaid/Healthy Montana Kids

Montana Medicaid will begin redeterminations of Medicaid coverage on April 1, 2023. Find out below how you can keep your Medicaid or find other insurance if you don’t qualify anymore.

What is changing?

1. DPHHS will begin redetermining Medicaid and Healthy Montana Kids members’ coverage in April 2023. This is because the continuous enrollment requirement for Medicaid/HMK members has ended. We will check if you are still eligible for Medicaid/HMK sometime in 2023.
   • If we need more information to determine your Medicaid/HMK eligibility, we will send you a redetermination packet. You must complete the packet if you receive one by mail or email, or your coverage will end.
   • Once we have finished processing your redetermination, DPHHS will send you a notice that will tell you whether your Medicaid/HMK will continue or end.
2. For most adults receiving Medicaid, DPHHS will now have to check if you still qualify for Medicaid each time we know of a change in your case. This includes changes in income or household size. We must check if you still qualify each time you report a change and each time our electronic databases show a change. We must end your coverage if you no longer qualify as a result of the change. For more information, see Continuous Eligibility Policy Change Notice for Members.

What do I need to do?

• Update your contact information - Make sure DPHHS has your current contact information so that you receive important notices. You can expect to hear from us by mail, email, and text message. Update your contact information here.
• Check your mail – DPHHS Office of Public Assistance will mail you a letter about your Medicaid or HMK coverage. This letter will also tell you if you need to complete a redetermination packet to see if you still qualify for Medicaid or HMK.
• Complete your redetermination packet (if you get one) - Call us at 1-888-706-1535, go to apply.mt.gov, or return the renewal packet by mail. You will have 30 days to complete this step. If you receive a redetermination packet, you must return it by the deadline, or your Medicaid/HMK will end.
• Report any changes in your household that might affect your eligibility for Medicaid. These include:
  • Changes in your address
  • If someone gets married or divorced
  • If someone moves in or out, becomes pregnant, adopts a child, or any other changes in the people who live in your home
  • If someone’s income changes
  • Report these changes to DPHHS within 10 days of knowing them by calling us at 1-888-706-1535 or by going to apply.mt.gov.
  • Respond to any requests for information you receive from DPHHS Office of Public Assistance. If we learn of any changes in your case through our electronic databases, we may contact you for more information to see if you are still eligible. If you are contacted by DPHHS OPA, you must respond by the due date, or your coverage will end.
  • Open mail from the Office of Public Assistance right away. If we find you are no longer eligible for Medicaid, you will need to take action to sign up for other insurance. If you don’t act right away, you will have a gap in healthcare insurance.

  What happens if I’m not eligible for Medicaid anymore?

  • You may be eligible for other low-cost, quality health insurance through HealthCare.gov (the Health Insurance Marketplace). If DPHHS finds that you are not eligible for Medicaid, we will send your information to HealthCare.gov.
  • Contact Cover Montana for help signing up for insurance through HealthCare.gov . They will connect you to free, confidential, and local help. Visit https://covermt.org/ or call 1-844-682-6837.
  • Take action right away! Contact Cover Montana or the HealthCare.gov as soon as you hear your Medicaid will end so that you don’t have a gap in coverage.
  Additional Background and Information about Upcoming Montana Medicaid Changes

  What happened with Medicaid eligibility during the COVID-19 public health emergency?

  A public health emergency was declared in March 2020 in response to the pandemic. Montana’s Department of Public Health and Human Services (DPHHS) adjusted its eligibility processes for Montana’s Medicaid and Healthy Montana Kids (HMK) programs to meet federal continuous enrollment requirements so individuals would keep their healthcare coverage during the emergency. The changes to eligibility processes included:

  • suspending the annual redetermination process of checking if individuals qualified for continued healthcare coverage,
  • not processing reported/discovered changes in circumstances (such as changes in income or household size) that would normally cause an individual to lose coverage, and
  • In most cases, not ending an individual’s coverage unless the individual requested it or moved out of state.

  What is changing?

  Resumption of normal eligibility processes and requirements:

  The December 2022 federal Omnibus Bill set April 1, 2023 as the end date for the continuous enrollment requirements and directed states to begin Medicaid redeterminations by that time. DPHHS will resume processing annual redeterminations and changes in Medicaid/HMK members’ circumstances and adjusting members’ coverage as appropriate on April 1, 2023. If DPHHS finds that an individual is no longer eligible for Medicaid/HMK coverage, DPHHS will send them a notice telling them their coverage will end and provide information on how to pursue coverage through HealthCare.gov, the federal Health Insurance Marketplace.

  What is the impact?

  Some individuals will need to take action to keep their coverage

  As DPHHS begins processing redeterminations, some individuals’ coverage will be able to be renewed through an automated process. Those individuals will receive a letter from DPHHS telling them they are eligible for continued coverage.

  Individuals whose coverage cannot be renewed by the automated process will receive a redetermination packet in the mail. It is imperative that individuals respond and complete their packet. Individuals who receive a redetermination packet must take one of these actions – call, go online, or return the mailed packet – for continued eligibility to be determined. If the individual does not complete their packet, their healthcare coverage will end. Households will have a minimum of 30 days to return their redetermination packet. DPHHS will send a follow up reminder notice and text message (to those with valid cell phone numbers) to encourage as many members to complete the process as possible.

  The best way for an individual to complete a redetermination packet is online at apply.mt.gov or by calling the Public Assistance Helpline at 1-888-706-1535. Completing the packet online or over the phone allows the individual to apply for or to recertify their SNAP or TANF benefits at the same time. If the individual completes the process by mailing or faxing the packet back to DPHHS, they must report any changes on the form and must sign and date it.

  Elimination of 12-month continuous eligibility for adults:

  Since the start of Medicaid expansion in 2016, Montana’s Medicaid program has had a policy of 12-month continuous eligibility for most adults receiving healthcare coverage. This meant that while individuals were required to report any changes that might affect their eligibility within 10 days of knowing about the change, in most cases, their Medicaid coverage continued for 12 months.

  The 2021 Montana State Legislature passed a budget that removed funding for 12-month continuous eligibility for most adults on Medicaid and directed DPHHS to end the policy. This change impacts adults covered by Medicaid Expansion as well as adults covered through the Parent/Caretaker Relative category of eligibility. DPHHS is now required to assess whether these individuals remain eligible for coverage each time DPHHS becomes aware of a change in their case, and to discontinue their coverage if they are no longer eligible.

  What is the impact?

  Potential loss of coverage

  If individuals report a change or DPHHS discovers a change through database checks, and DPHHS finds they are no longer eligible for healthcare coverage, DPHHS will notify them that their enrollment will be ending. DPHHS will send their information to HealthCare.gov to begin an application for health insurance, and individuals who want coverage will need to contact HealthCare.gov to complete the application.

  If the individual doesn’t have any changes that affect eligibility, coverage will continue for up to one year, at which time another eligibility determination will occur.

  This change does not impact children covered by Medicaid or Healthy Montana Kids or a small number of adults covered by Medicaid for people with Severe Disabling Mental Illness. These groups will maintain 12-month continuous eligibility, so in most instances a reported change will not impact their healthcare coverage until their redetermination date.

  How Community Partners Can Help

  Community partners have important relationships with Montanans who have Medicaid/Healthy Montana Kids and can play a valuable role in helping them stay covered. Here’s how partners can support Medicaid/HMK enrollees through the upcoming changes:

  • Spread the word about the importance of individuals updating their contact information with Medicaid. DPHHS will be sending important mail, and Medicaid/HMK members need to make sure DPHHS has their current address, phone number, and email. Updates to contact information can be made by doing any of the following:
    • Complete a change of address form online at: apply.mt.gov . At apply.mt.gov, individuals can also create an online account. An online account allows individuals to update their contact information, renew their coverage when it’s time, and receive correspondence.
    • Call the Public Assistance Helpline at 1-888-706-1535
    • Mail a letter to: DPHHS, PO Box 202925, Helena, MT 59620-2925
    • Fax a letter to 1-877-418-4533
    • Go to the local Office of Public Assistance
    • Download free resources and request printed materials to share with clients and community members from Cover Montana.
      • Cover Montana will ship flyers and handouts to you for free. Information about how to request yours is here.
      • Download their communications toolkit for partners who want to help spread the word with their patients, clients, or community about the upcoming changes. The toolkit includes guidance around messaging to those enrolled in Medicaid, sample social media, how to integrate this information into organizational communication, and where to refer folks who need additional support.
      • Answer basic questions from individuals with Medicaid/HMK about what they need to do.
      • Encourage individuals with Medicaid/HMK to complete their redetermination packet or requests for additional documentation by going to apply.mt.gov or calling the Montana Public Assistance Helpline at 1-888-706-1535.
      • Refer individuals who need help navigating the Medicaid redetermination process or finding other healthcare coverage to Cover Montana athttps://covermt.org/or (844) 682-6837. Cover Montana will connect them with free, confidential, and local help with healthcare coverage.
      • Urge anyone who loses their Montana Medicaid to apply for insurance through HealthCare.gov right away so they don’t have a gap in coverage. Refer them to Cover Montana for individual, one-on-one assistance. You can also direct them to visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325).
      Information for Healthcare Providers

      Providers have a uniquely important role helping their patients navigate the healthcare and health insurance systems. You can help your patients with Medicaid/Healthy Montana Kids stay covered. Here’s how you can help:

      • Spread the word about the importance of individuals updating their contact information with Medicaid. DPHHS will be sending important mail and Medicaid/HMK members need to make sure DPHHS has their current address, phone number and email. Updates to contact information can be made by doing any of the following:
        • Complete a change of address form online at: apply.mt.gov . At apply.mt.gov, individuals can also create an online account. An online account allows individuals to update their contact information, renew their coverage when it’s time, and receive correspondence.
        • Call the Public Assistance Helpline at 1-888-706-1535
        • Mail a letter to: DPHHS, PO Box 202925, Helena, MT 59620-2925
        • Fax a letter to 1-877-418-4533
        • Go to the local Office of Public Assistance
        • Ask patients if the address you see in the Montana Access to Health provider portal is their current mailing address. If it is, they do not need to update their contact information. If it is not, have them update their information using one of the methods above. If possible, have patients update it on the spot using the link at the top of apply.mt.gov.
        • Download free resources and request printed materials to share with clients and community members from Cover Montana.
          • Cover Montana will ship flyers and handouts to you for free. Information about how to request yours is here.
          • Download their communications toolkit for partners who want to help spread the word with their patients, clients, or community about the upcoming changes. The toolkit includes guidance around messaging to those enrolled in Medicaid, sample social media, how to integrate this information into organizational communication, and where to refer folks who need additional support.
          • Answer basic questions from patients with Medicaid coverage about what they need to do.
          • Encourage patients with Medicaid/HMK to complete their redetermination packet or requests for additional documentation by going to apply.mt.gov or calling the Montana Public Assistance Helpline at 1-888-706-1535.
          • Refer patients who need help navigating the Medicaid redetermination process or finding other healthcare coverage to Cover Montana athttps://covermt.org/or (844) 682-6837. Cover Montana will connect them with free, confidential, and local help with healthcare coverage.
          • Urge patients who lose their Montana Medicaid/HMK to apply for insurance through HealthCare.gov right away so they don’t have a gap in coverage. Refer them to Cover Montana for individual, one-on-one assistance. You can also direct them to visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325).
          1. I have Medicaid/Healthy Montana Kids. What do I need to do? Here are the three most important things you need to do:
             • Update your contact info so you receive notices – update it online here, or call 1-888-706-1535 and choose the first option
             • Check your mail and open any mail from DPHHS Office of Public Assistance right away
             • Complete your redetermination if you get a renewal packet in the mail – by going online to apply.mt.gov, calling 1-888-706-1535, or returning the renewal packet by mail
          2. When do I need to take action? Update your contact information with us right away, and any time it changes in the future. Check your mail regularly for notices from DPHHS Office of Public Assistance. If you get a renewal packet, complete it by the due date.
          3. Will I receive an email confirmation that DPHHS OPA has received the renewal packet that I mailed back?
             No. The next communication you will receive from DPHHS OPA is a notice sent by USPS mail requesting additional information or telling you that your coverage will continue or will end.
          4. If my Medicaid coverage is renewed, will I receive a new Medicaid card?
             No. Montana Medicaid only sends Medicaid cards to an individual the first time they are approved for Medicaid coverage. Please keep your card for future use. If you need to request a new card, call the Public Assistance Helpline at 1-888-706-1535 and select 2-2-1-3-2, or request one at apply.mt.gov by asking Sophie, the virtual bot.
          5. When are redeterminations and all these changes happening? Redeterminations will begin on April 1, 2023. 12-month continuous eligibility will end for most adults on that date. Redeterminations will happen over 10 months, so yours might not happen until the end of 2023.
          6. What’s the difference for me between the end of continuous coverage and the end of 12-month continuous eligibility? We need to review your coverage over the next year to see if you’re still eligible because of the end of the continuous coverage rule. The end of 12-month continuous eligibility means that your coverage may not last for a full 12 months if you have changes in income or household size. It means you must tell us of any changes, and we must end your coverage if you are no longer eligible. If you don’t have any changes, your coverage will continue for 12 months.
          7. What If I have a change? Report changes to us, such as a change in household income or changes on who resides in your home (marriage, divorce, birth of child, adoption, etc.). How do I report a change? You can call us at 1-888-706-1535, stop by a local OPA office, mail a letter to PO Box 202925 Helena MT 59620-2925, fax us at 1-877-418-4533, or create an online account at apply.mt.gov. You can report changes in address only here.
          8. What happens when I report a change? What happens to my child on HMK? We will re-evaluate if you still qualify for Medicaid. If you are an adult who has Medicaid based on income and your changes make you no longer eligible for Medicaid, we must end your coverage. If you are an adult who has Medicaid because you have a Severe Disabling Mental Illness, your coverage will continue for the full 12-month period. Your child will continue to have coverage for the rest of the 12-month period since their coverage began or their last renewal.
          9. What if I no longer qualify for Medicaid? If you no longer qualify, we will tell you at least 10 days before your coverage ends. You can appeal our decision if you believe we made a mistake. We will forward your information to HealthCare.gov to see if you qualify for other reduced-cost health coverage. You will need to act quickly to sign up for other health insurance, or you will have a gap in coverage. Contact Cover Montana (phone: 1-844-682-6837) or HealthCare.gov (phone: 1-800-318-2596) right away. Cover Montana offers free, confidential, and local assistance.
          10. What if I need help or have questions? You can contact Cover Montana if you need help understanding your benefits, reporting changes, or signing up for coverage through the Health Insurance Marketplace. They are free, confidential, and local. Visit https://covermt.org or call 1-844-682-6837.
          11. What was the Continuous Coverage requirement? In March 2020, Congress passed the Medicaid continuous coverage requirement as part of the Families First Coronavirus Response Act. In exchange for an increase in federal Medicaid matching funds (FMAP), states were required to keep Medicaid enrollees in the program until the end of the month in which the COVID Public Health Emergency ended, eliminating the need to reevaluate their eligibility and ensuring that people retained coverage during the pandemic. In response, Montana Medicaid suspended annual renewals, and individuals maintained their health coverage throughout the multi-year period, even if they had changes that made them no longer eligible. The Omnibus spending bill Congress passed in December of 2022 de-linked the continuous coverage requirement from the federal Public Health Emergency declaration, instead setting a date certain for the end of the continuous enrollment requirement, which is April 1, 2023.
          12. What happens when the Continuous Coverage requirement ends? DPHHS is required to re-evaluate and either renew or terminate Medicaid/HMK coverage for every single individual receiving Medicaid/HMK. DPHHS anticipates completing these redeterminations over a ten month period. At the same time that the Continuous Coverage requirement ends, Montana’s 12-month continuous eligibility policy will also end for most adults. DPHHS will resume processing reported changes in circumstances and adjusting coverage as appropriate.
          13. What is 12-month continuous eligibility? It’s a policy that meant that people who qualified for Medicaid would keep that coverage for a 12-month period, even if they had changes that would otherwise make them ineligible (for example, an increase in income). Montana first enacted this policy for children covered under Medicaid/HMK. Since the start of Medicaid expansion in 2016, Montana’s Medicaid program has had a policy of 12-month continuous eligibility for most adults receiving healthcare coverage. This meant that while individuals were required to report any changes that might affect their eligibility within 10 days of knowing about the change, in most cases, their Medicaid coverage continued regardless of those changes for 12 months.
          14. What’s changing with 12-month continuous eligibility? The 2021 Montana Legislature passed a budget that removed funding for 12-month continuous eligibility for most adults on Medicaid and directed DPHHS to end the policy. This change impacts adults covered by Medicaid Expansion as well as adults covered through the Parent/Caretaker Relative category of eligibility under the WASP waiver. DPHHS received approval from CMS to implement the change at the end of the federal continuous coverage requirement – which will now occur on April 1, 2023. This means that, beginning April 1, 2023, DPHHS will be required to assess whether these individuals remain eligible for coverage each time DPHHS becomes aware of a change in their case, and to discontinue their coverage if they are no longer eligible. The 12-month continuous eligibility policy will remain in place for children and adults with Severe Disabling Mental Illness.
          15. Will changes to continuous eligibility affect children on Medicaid? No. These changes will not impact children covered by Medicaid or Healthy Montana Kids. Children will maintain 12 months of continuous eligibility, so most reported changes will not affect ongoing coverage until their renewal.
          16. What is the connection between the end of the Continuous Coverage requirement and the end of 12-month continuous eligibility? Both will occur at the same time. DPHHS received approval from CMS to end the 12-month continuous eligibility policy in 2022, but the approval stipulated that it could not take effect until the end of the federal continuous coverage requirement.
          17. What is the process for redeterminations? DPHHS attempts to automatically redetermine coverage for all Medicaid/HMK members who qualify for Medicaid/HMK based on income criteria alone. If DPHHS is unable to renew coverage using automated interfaces and information exchange, DPHHS sends a renewal packet to the member (approximately 45 days prior to the expiration of coverage). The member must complete the redetermination within 30 days, or their coverage will end.
          18. When will DPHHS start removing ineligible participants from the Medicaid rolls? Redeterminations will begin on April 1, 2023. The soonest coverage could end for ineligible individuals is May 1, 2023.
          19. How will DPHHS notify Medicaid members about the upcoming changes? DPHHS will use a combination of mailed notices, text messaging, website updates, social media, and collaboration with community partners to reach Medicaid members. The Department has already begun reaching out to Medicaid members and community partners to prepare individuals and partner organizations for the changes that are coming. This included the campaign last year encouraging individuals to update their contact information with Medicaid, so that DPHHS can reach them when it’s time to redetermine their coverage. DPHHS has worked with Cover Montana, health care providers, tribal partners, and community organizations to help spread the word. As part of the campaign to update contact information, the Department has sent approximately 73,000 text messages to households most likely to have new mailing addresses, encouraging them to update their contact information. DPHHS will send notices to all affected members informing them of the change in the continuous eligibility policy. This notice will remind enrollees about their obligation to report changes in income, family size, or other circumstances to DPHHS. Members will only be contacted by DPHHS regarding their renewal process if DPHHS is unable to automatically renew them and needs more information from them.
          20. How many days will Medicaid members have to complete their redeterminations? Households will have a minimum of 30 days to return their renewal packet. DPHHS will send a follow up reminder notice and text message to encourage as many members to complete the process as possible.
          21. How long do individuals have to appeal after DPHHS determines that individual is no longer eligible? If an individual is determined to no longer be eligible, and the individual feels they followed all requirements and that the closure/denial is incorrect, they may request a Fair Hearing. This request must be in writing and received by DPHHS/Office of Public Assistance within 90 days of the negative action for most cases.
          22. How will DPHHS connect enrollees who lose Medicaid coverage to other sources of coverage such as the HealthCare.gov? When an individual is determined no longer eligible for Medicaid/HMK coverage, DPHHS will automatically transfer that individual’s information to HealthCare.gov. DPHHS will send the individual a notice telling them their coverage will end and provide information on how to pursue coverage through HealthCare.gov, as well as inform them of local enrollment assistance available through Cover Montana. Cover Montana is the Montana navigator grantee and is partnering with Medicaid to assist members who need assistance signing up for new health coverage. Montanans can find this free, confidential, local help at https://covermt.org/find-local-help/, or by calling (844) 682-6837.
          23. The renewals will happen over a number of months. Is there any way for someone to know in advance when they will go through the renewal process? After April 10, 2023, members with an apply.mt.gov account can log into their account and use the “Check My Benefits” feature to see their redetermination month.
          24. Will DPHHS increase staffed locations, call centers or other personnel to handle inquiries about this process? In an effort to make sure redeterminations are made efficiently and timely, the department has engaged Public Consulting Group (PCG) to provide staff augmentation services for a limited number of months starting in April. The additional staff will provide direct service to clients, will use the department’s eligibility system and will be trained by department staff.
          25. How is the state expanding use of data matching or use of other government databases to check an individual’s income or residency eligibility requirements? Montana currently utilizes robust data matching and will continue to use these interfaces as part of the Medicaid eligibility process. DPHHS utilizes over 25 interfaces from state and federal sources. Several of these interfaces provide information on income (including wage, self-employment and social security income), and residency.
          26. How many members or what percent of members will lose coverage as a result of redeterminations done after April 1 due to loss of eligibility? Medicaid eligibility considers point in time information about individuals and families at application and redetermination of benefits. The circumstances of many Montanans have changed since March 2020 and DPHHS will not be able to estimate the impact on the eligibility of members without the opportunity to properly consider case-by-case information. If DPHHS finds that an individual is no longer eligible for Medicaid/HMK coverage, DPHHS will send them a notice telling them their coverage will end and provide information on how to pursue coverage through HealthCare.gov, the federal Health Insurance Marketplace.
          27. Does the end of 12-month continuous eligibility mean that Medicaid members will have to reapply or renew their coverage more frequently? No. Members who have no changes in their circumstances, such as change in income or household members, will have Medicaid coverage for 12 months, as they had before. The difference is that now, if DPHHS receives information during a person’s 12-month coverage period that indicates that member has changes in their circumstances, DPHHS is required to re-assess if the member still qualifies. DPHHS may send a request for confirmation/additional information to the member. Existing enrollees do not need to ‘reapply’ but may need to provide additional information to retain coverage. If the new information makes them ineligible, DPHHS must terminate their coverage.
          Sample Notices
          • Continuous Eligibility Policy Change Notice for Members
          • Medicaid Redeterminations Notice for Members
          • Redetermination Reminder
          • Redetermination Supplement
          • Renewal Notice & Form
          • Sample Approval Notice
          • Sample Closure Notice – Example A Failure to Renew
          • Sample Closure Notice – Example B
          • Sample Communication from Health Insurance Marketplace
          • Sample Reminder Text Message for Members