2023 Montana Code Annotated › Title 53. Social Services and Institutions › Chapter 6. Health Care Services › Part 13. Montana Health and Economic Livelihood Partnership (HELP) Act › 53-6-1307. Premiums -- collection of overdue premiums -- nonpayment as voluntary disenrollment -- reenrollment -- exemptions

53-6-1307. (Temporary) Premiums -- collection of overdue premiums -- nonpayment as voluntary disenrollment -- reenrollment -- exemptions.
(1) (a) A program participant shall pay an annual premium, billed monthly, equal to a percentage of the participant's modified adjusted gross income as determined in accordance with 42 U.S.C. 1396a(e)(14). Except as provided in subsection (1)(b), the premiums must:
(i) be set at 2% of a participant's income in the first 2 years the participant receives coverage under this part; and
(ii) increase by 0.5% in each subsequent year that a participant receives coverage, up to a maximum of 4% of the participant's income.
(b) A program participant who is exempt from the community engagement requirements as allowed under 53-6-1308 is exempt from the premium increases in subsection (1)(a)(ii).
(c) Premiums paid pursuant to this section must be deposited in the Montana HELP Act special revenue account provided for in 53-6-1315.
(2) Within 30 days of a participant's failure to make a required payment, the department or a third-party administrator administering the program, if any, shall notify the participant that payment is overdue and that all overdue premiums must be paid within 90 days of the date the notification was sent.
(3) (a) If a participant with an income of 100% of the federal poverty level or less fails to make payment for overdue premiums, the department shall provide notice to the department of revenue of the participant's failure to pay. The department of revenue shall collect the amount due for nonpayment by assessing the amount against the participant's annual income tax in accordance with Title 15, chapters 1 and 30.
(b) The debt remains until paid and may be collected through assessments against future income tax returns or through a civil action initiated by the state.
(4) If a participant with an income of more than 100% but not more than 138% of the federal poverty level fails to make the overdue payments within 90 days of the date the notification was sent, the department shall:
(a) follow the procedure established in subsection (3) for collection of the unpaid premiums; and
(b) consider the failure to pay to be a voluntary disenrollment from the program. The department may reenroll a participant in the program upon payment of the total amount of overdue payments.
(5) If a participant who has failed to pay the premiums does not indicate that the participant no longer wishes to participate in the program, the department may reenroll the person in the program when the department of revenue assesses the unpaid premium through the participant's income taxes.
(6) Participants who meet two of the following criteria are not subject to the voluntary disenrollment provisions of this section:
(a) discharge from United States military service within the previous 12 months;
(b) enrollment for credit in any Montana university system unit, a tribal college, or any other accredited college within Montana offering at least an associate degree, subject to the provisions of subsection (7);
(c) participation in a workforce program or activity established under Title 39, chapter 12; or
(d) participation in any of the following healthy behavior plans developed by a health care provider or third-party administrator, if any, or approved by the department:
(i) a medicaid health home;
(ii) a patient-centered medical home;
(iii) a cardiovascular disease, obesity, or diabetes prevention program;
(iv) a program restricting the participant to obtaining primary care services from a designated provider and obtaining prescriptions from a designated pharmacy;
(v) a medicaid primary care case management program established by the department;
(vi) a tobacco use prevention or cessation program;
(vii) a medicaid waiver program providing coverage for family planning services;
(viii) a substance abuse treatment program; or
(ix) a care coordination or health improvement plan administered by the third-party administrator.
(7) A participant seeking an exemption under subsection (6) is not eligible for the education exemption provided for in subsection (6)(b) for more than 4 years. (Void on occurrence of contingency--sec. 45, Ch. 415, L. 2019; terminates June 30, 2025--secs. 38, 48, Ch. 415, L. 2019.)
53-6-1307. (Temporary -- effective on occurrence of contingency) Premiums -- collection of overdue premiums -- nonpayment as voluntary disenrollment -- reenrollment -- exemptions.
(1) (a) A program participant shall pay an annual premium, billed monthly, equal to 2% of the participant's income as determined in accordance with 42 U.S.C. 1396a(e)(14).
(b) Premiums paid pursuant to this section must be deposited in the general fund.
(2) Within 30 days of a participant's failure to make a required payment, the department or a third-party administrator administering the program, if any, shall notify the participant that payment is overdue and that all overdue premiums must be paid within 90 days of the date the notification was sent.
(3) (a) If a participant with an income of 100% of the federal poverty level or less fails to make payment for overdue premiums, the department shall provide notice to the department of revenue of the participant's failure to pay. The department of revenue shall collect the amount due for nonpayment by assessing the amount against the participant's annual income tax in accordance with Title 15, chapters 1 and 30.
(b) The debt remains until paid and may be collected through assessments against future income tax returns or through a civil action initiated by the state.
(4) If a participant with an income of more than 100% but not more than 138% of the federal poverty level fails to make the overdue payments within 90 days of the date the notification was sent, the department shall:
(a) follow the procedure established in subsection (3) for collection of the unpaid premiums; and
(b) consider the failure to pay to be a voluntary disenrollment from the program. The department may reenroll a participant in the program upon payment of the total amount of overdue payments.
(5) If a participant who has failed to pay the premiums does not indicate that the participant no longer wishes to participate in the program, the department may reenroll the person in the program when the department of revenue assesses the unpaid premium through the participant's income taxes.
(6) Participants who meet two of the following criteria are not subject to the voluntary disenrollment provisions of this section:
(a) discharge from United States military service within the previous 12 months;
(b) enrollment for credit in any Montana university system unit, a tribal college, or any other accredited college within Montana offering at least an associate degree, subject to the provisions of subsection (7);
(c) participation in a workforce program or activity established under Title 39, chapter 12; or
(d) participation in any of the following healthy behavior plans developed by a health care provider or third-party administrator, if any, or approved by the department:
(i) a medicaid health home;
(ii) a patient-centered medical home;
(iii) a cardiovascular disease, obesity, or diabetes prevention program;
(iv) a program restricting the participant to obtaining primary care services from a designated provider and obtaining prescriptions from a designated pharmacy;
(v) a medicaid primary care case management program established by the department;
(vi) a tobacco use prevention or cessation program;
(vii) a medicaid waiver program providing coverage for family planning services;
(viii) a substance abuse treatment program; or
(ix) a care coordination or health improvement plan administered by the third-party administrator.
(7) A participant seeking an exemption under subsection (6) is not eligible for the education exemption provided for in subsection (6)(b) for more than 4 years. (Terminates June 30, 2025--secs. 38, 48, Ch. 415, L. 2019.)
History: En. Sec. 7, Ch. 368, L. 2015; amd. Sec. 35, Ch. 415, L. 2019.