Health and Economic Livelihood Partnership 1115 Demonstration Waiver

On Sept. 2, 2025, the Department of Public Health and Human Services (DPHHS) submitted an 1115 Demonstration waiver to the U.S. Centers for Medicare & Medicaid Services (CMS) to align the state’s Medicaid Expansion program with the One Big Beautiful Bill Act (HR 1) and implement community engagement and cost sharing (in the form of premiums) for this coverage group.

Based on feedback from CMS, DPHHS intends to pursue community engagement authority through a State Plan Amendment, but will continue to seek premium authority through an 1115 Demonstration waiver.

These changes are administrative in nature and will not change planned implementation timelines or the requirement for this coverage group to meet applicable requirements.

DPHHS is committed to being operationally ready for implementation by July 1, 2026, and remains engaged in productive discussions with federal partners.

Public Notification

• Health and Economic Livelihood Partnership 1115 Demonstration Waiver Application – 9-2-25
• Public Notice – 7-18-25
• 60 Day Notice of HELP Section 1115 Waiver  –  7-3-2025
• Tribal Consultation Letter - 6-20-2025

Public Meetings

• Public Meeting 8-1-25
  • This meeting was held as part of the Montana Health Coalition meeting.
  • Meeting Materials: August 2025 Agenda and 1115 HELP Health Coalition Memo 7-18-25

• Public Meeting 7-31-25
  • Meeting Materials:  July 2025 Agenda and HELP 1115 Demonstration Waiver Presentation 7-31-25

• Tribal Consultation – 7-29-25
  • DPHHS hosted formal tribal consultation to allow all Tribal Governments, Urban Indian Organizations, and the Indian Health Service to comment on the application.
  • Meeting Materials: July 29th Tribal Consultation Agenda and Tribal Consultation Presentation 7-29-25

Relevant Regulations

• MCA 53-6-1307. Premiums -- collection of overdue premiums -- nonpayment as voluntary disenrollment -- reenrollment -- exemptions, MCA
• MCA 53-6-1308. Community engagement requirements -- countable activities -- exemptions -- self-attestation, MCA
• MCA 53-6-1309. Community engagement -- reporting -- suspension -- audit, MCA