Medicaid Expansion Community Engagement Requirements
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This state plan amendment establishes community engagement requirements for Montana Medicaid Expansion (HELP Program) participants, describing required activities, hours, verification, exclusions, and communications; it affects all Medicaid Expansion participants who do not meet exclusion criteria.
No material clinical or coverage changes in this revision.
Community Engagement Compliance
Community Engagement Compliance Criteria
Covered when ALL of the following are met unless the participant qualifies for an exclusion:
ALL of the following
- Working at a job
- Community service or volunteering
- Workforce training or job readiness programs through the State of Montana
- Internships or registered apprenticeships
- Attending school (college or vocational school)
ALL of the following
- Proof such as pay stubs, official school letters, or signed volunteer logs
- Verification may be completed via data matching with other state programs
- Or via self-reporting online, by phone, by mail, or in person using approved methods
ALL of the following
- American Indian/Alaska Native
- Children age 18 or younger
- Adults age 65 or older
- Pregnant or postpartum individuals (up to 12 months)
- Former foster youth
- Parents or caregivers of children under age 14
- Parents/caregivers of persons with disabilities
- Veterans with disabilities rated as total
- People who are medically frail
- People enrolled in treatment programs for substance use disorder
- Individuals currently incarcerated or recently released
- Individuals eligible for Medicare
Coding and Thresholds
Verification, Notifications, and Compliance
Verification requirements for community engagement
Participants must prove they are meeting community engagement requirements. Acceptable verification includes pay stubs, official letters from school, or signed volunteer logs. Completion may also be verified through data matching with other state programs or self-reporting online, by phone, by mail, or in person using approved methods.
- Pay stubs from their job
- Official letters from school
- Signed volunteer logs showing their hours
- Data matching with other state programs
- Self-reporting online, by phone, by mail, or in person using approved methods
Notification and 30-day compliance cure period
DPHHS will notify current Medicaid Expansion participants three months before implementation about the requirements and how to submit documentation. If a participant is found noncompliant, DPHHS will issue a notice giving the participant 30 days to come into compliance; failure to comply within that 30-day period may result in loss of Medicaid coverage.
- Three-month advance notification explaining requirements and how to submit documentation or claim an exclusion
- 30-day notice to come into compliance after noncompliance is identified
- Potential loss of Medicaid coverage if noncompliance is not cured within 30 days
Program and Exclusion Definitions
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