Health and Economic Livelihood Partnership
1115 Demonstration Waiver

The Montana Department of Public Health and Human Services (DPHHS) is providing public notice of its intent to: (1) submit to the Centers for Medicare and Medicaid Services (CMS) a Section 1115 Demonstration application to request federal authority for enrollees to be subject to community engagement requirements and cost sharing as a condition of Medicaid enrollment in accordance with HR 1 and the Montana Code Annotated and (2) hold public hearings to receive comments on the 1115 Demonstration application.

DPHHS is seeking a five-year approval of the Demonstration and aims to implement the waiver as soon as is practicable following federal approval.

DPHHS is seeking a Section 1115 Demonstration waiver to comply with Montana legislative requirements (MCA 53-6-1307, 53-6-1308, and 53-6-1309) and advance the Gianforte administration’s commitment to helping Montanans become self-sufficient and independent while reducing government dependency. DPHHS will also seek to align and comply with recently enacted federal requirements included in HR 1 related to community engagement and cost sharing for Medicaid enrollees.

Public Meetings and Comment Process

In accordance with federal regulation (42 CFR § 431.408), DPHHS is providing the public and other interested parties with the opportunity to review and offer input on the waiver through a formal, 30-day public notice and comment process, which will run from July 18, 2025, to August 18, 2025.

The draft Montana HELP waiver application is here. The full public notice is here.

Several public meetings will be held regarding the Demonstration application:

July 29, Tribal Consultation (virtual only)

DPHHS will host a formal tribal consultation on Tuesday, July 29 from 3 p.m. to 5 p.m. to allow all Tribal Governments, Urban Indian Health Centers, and the Indian Health Service to comment on the application. To register for the meeting, click the Zoom link.

An agenda will be posted closer to the meeting date.

July 31 Public Meeting Information (hybrid meeting)

On Thursday, July 31 from 3 p.m. to 5 p.m. a public meeting will be held at the DPHHS Cogswell Building located at 1400 East Broadway St. in conference rooms C205, C207, and C209. To attend in person, participants are encouraged to use the south Cogswell entrance off Broadway. Ample parking is available in an adjacent parking lot next to the Sanders Building located at 111 North Sanders.

To register for the meeting, click the Zoom link. An agenda will be posted closer to the meeting date. 

August 1 Public Meeting (virtual only to the public)

On Friday, Aug. 1, from 3 p.m. to 5 p.m., a public meeting will be held as part of a Montana Health Coalition meeting and will be accessible to the public virtually only due to building security restrictions. To register for the meeting, click the Zoom link. An agenda will be posted closer to the meeting date. 

Individuals who require special accommodation to attend these public meetings should contact Carla Rime at (406) 444-2584 or by email at crime2@mt.gov to ensure that any necessary accommodation can be provided.

Questions or formal public comments may be submitted until 11:59 pm MT on August 18, 2025. Questions or public comments may be submitted via email to dphhscomments@mt.gov with “HELP Demonstration Waiver” in the subject line, or by mail to:

Department of Public Health and Human Services

Director’s Office
RE: HELP Waiver
P.O. Box 4210
Helena, MT 59604-4210

Please note that comments will continue to be accepted after August 18, but the state may not be able to consider those comments prior to the submission of the Demonstration application to CMS.

For more information, contact Carla Rime at (406) 444-2584 or email crime2@mt.gov. 

Relevant Regulations

Public Notification