Health and Economic Livelihood Partnership 1115 Demonstration Waiver

The Montana Department of Public Health and Human Services (DPHHS) has submitted 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. In July and August, DPHHS held 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.

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

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