State Exchange Profiles: Montana


Final update made on April 19, 2013 (no further updates will be made)

Establishing the Exchange

In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.1 The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed in the Affordable Care Act of 2010. Governor Brian Schweitzer (D) vetoed SB 228 on April 13, 2011.4 Later in April, the legislature issued HJR 33, a joint resolution to allow the Economic Affairs Interim Committee to study the implications, options, and repercussions of a state-based health insurance exchange.5

Also in April 2011, the Governor vetoed SB 176, which would have prohibited qualified health plans participating in a health insurance exchange in Montana from covering abortions, except in cases of life endangerment or severe health impairment of the pregnant woman.6

Contracting with Plans: On February 26, 2013, Commissioner Lindeen sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Office of the Commissioner of Securities and Insurance (CSI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). CSI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. CSI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.7

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Montana has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Montana- Blue Dimensions.

Exchange Funding

The Montana State Auditor received a federal Exchange Planning grant of $1 million in 2010.

Next Steps

On March 8, 2013, Montana received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.8

1. Dennison, M. “Lindeen: Feds Will Have Health Insurance Exchange Up Next Year.” Billings Gazette. December 10, 2012.
2. HB 620. Montana bill to generally revise health care law to create health care gateway. 2011.
3. HB 124. Montana bill to create a state-level health insurance exchange. 2011.
4. SB 228. Montana act prohibiting creation of a state-based health insurance exchange under the Patient Protection and Affordable Care Act. 2011.
5. HJ 33. Montana’s joint resolution for an interim study of a health insurance exchange.
6. SB176. Montana’s 2011 act to prohibit plans in the exchange from covering abortion.
7. Letter from Commissioner Lindeen to Gary Cohen. February 26, 2013.
8. Letter from Gary Cohen to Commissioner Lindeen. March 8. 2013.

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