As Montana officially became the 30th state to expand Medicaid earlier this month, it became the first to do so with a third-party program administrator: Blue Cross and Blue Shield of Montana. The company is now ramping up to step into its new role.
BCBSMT Director of Public Relations John Doran expressed enthusiasm over the news 5,550 people had signed up for coverage in the first week under the state’s new Health and Economic Livelihood Partnership (HELP) Act.
“This is an encouraging number of enrollees and demonstrates the significant need Montanans within this income level have to get access to the care they need,” Doran told Healthcare Dive over email. He says at this time, all enrollment is being processed through HealthCare.gov or directly through the Montana Department of Health and Human Services (DPHHS). BCBSMT will take enrollment files in early December and begin distributing welcome packets in mid-December.
In the meantime, they have their work cut out for them.
“We have been working diligently since submitting our proposal in mid-August, and more aggressively since being awarded the contract, to build the proper technology platforms and processes to have the program up and running successfully by January 1,” Doran says. He adds they are collaborating closely with DPHHS throughout the process.
Doran says the company has two work streams striving to implement the program: 1) a team focused on project structure, and 2) a team focused on program governance.
The project structure work team is primarily engaged in building the technology platform and processes for accurately processing the premiums, co-pays and maximum out-of-pocket costs participants will pay, Doran says. Montana got a federal waiver to include a unique provision in its expansion program that requires beneficiaries to pay premiums amounting to 2% of their income.
The program governance work team is focused on ensuring compliance with all state and federal regulations through the contract, waivers, and administrative rules, Doran says.
He adds there are numerous cross-functional areas in each work stream, and within that framework, they participate weekly in a joint oversight committee with DPHHS to go over progress and resolve potential issues.
In addition, their network management team has been occupied with building the provider network specifically for HELP. “We have made great progress in a short amount of time to contract with physicians, behavioral health specialists, facilities, and all other providers needed to give HELP participants broad access to the healthcare they need,” Doran says.
He says all preparations are progressing well and the company is confident it will be ready on January 1, 2016.
Doran says BCBSMT is unaware of whether they are likely to set a precedent for any other states or insurers to team up on Medicaid expansion.
“The state of Montana and its legislature elected to implement the HELP program in this fashion. I cannot predict what other Blue plans or states might do,” he says. “Once again, we are honored to be able to work with the state and providers across Montana to make the HELP program a success.”
BCBSMT is Montana's largest and longest-standing health insurer and third-party administrator, the company says, having just reached its 75th year in the state. It has served as the TPA for the Healthy Montana Kids program (formerly the Children's Health Insurance Program).