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In 2015, Montana received approval from the Centers for Medicare and Medicaid Services to implement an Affordable Care Act Medicaid expansion demonstration. Called Montana Health and Economic Livelihood Partnership (HELP) plan, the demonstration encourages enrollees to be prudent health care purchasers and to take personal responsibility for their health care through the use of premiums, copayments and strategies to promote healthy behaviors. This report presents early findings from the federal evaluation of HELP based on a site visit conducted in September 2018 with range of stakeholders and focus groups with HELP enrollees. We found that HELP launch went smoothly with only minor glitches and enrollment in the program has far exceeded the state’s projections, covering more than 80,000 Montanans 18 months after implementation. Enrollees in focus groups said HELP premiums were fair and affordable even though program administrative data indicate many enrollees struggle to pay premiums on time. Providers reported being happy with HELP but also reported they are not collecting copayments because of high administrative costs and because of low expectations of receiving payment. Finally, access to care was described as being generally consistent with that of the privately insured.

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