Montana Administrative Register Notice 37-573 No. 7   04/12/2012    
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In the matter of the amendment of ARM 37.82.701, 37.86.1701, 37.86.1705 and 37.86.1706 pertaining to plan first 1115 waiver implementation







            TO:  All Concerned Persons


1.  On February 9, 2012, the Department of Public Health and Human Services published MAR Notice No. 37-573 pertaining to the public hearing on the proposed amendment of the above-stated rules at page 298 of the 2012 Montana Administrative Register, Issue Number 3.


2.  The department has amended ARM 37.86.1701, 37.86.1705, and 37.86.1706 as proposed.


3.  The department has amended the following rule as proposed, but with the following changes from the original proposal, new matter underlined, deleted matter interlined:


            37.82.701  GROUPS COVERED, NONINSTITUTIONALIZED FAMILIES AND CHILDREN  (1)  Medicaid will be provided to:

            (a)  individuals under age 19 who currently reside in Montana and are receiving foster care, guardianship, or adoption assistance under Title IV-E of the Social Security Act, whether or not such assistance originated in Montana.  Eligibility requirements for Title IV-E foster care and adoption assistance are found in ARM 37.50.101, 37.50.105, 37.50.106, and 45 CFR part 233.

            (b) through (3) remain as proposed.


AUTH:  53-4-212, 53-4-1105, 53-6-113, MCA

IMP:     53-4-231, 53-4-1104, 53-4-1105, 53-6-101, 53-6-131, 53-6-134, MCA


4.  The department has thoroughly considered the comments and testimony received.  A summary of the comments received and the department's responses are as follows:


COMMENT #1:  Several commenters voiced their concerns regarding the costs of unintended pregnancies.  They explained that the cost of an unplanned pregnancy to Montana Medicaid is $12,257 whereas the cost of providing family planning services and contraceptives is $272.24.  They said that 35% of Montana births are covered by Medicaid.  They also explained the federal government participates in the Plan First waiver funding further reducing expenses to Montanans.

RESPONSE #1:  The department agrees that there will be cost savings as a result of these rule amendments.

 COMMENT #2:  Several commenters expressed their frustration that the 2011 Legislature eliminated state funding of Montana's family planning clinics.

 RESPONSE #2:  The comments are beyond the scope of the proposed rule amendments.  The commenters are encouraged to contact their senators and representatives.

COMMENT #3:  One commenter explained that unintended pregnancies lead to less than optimum outcomes which include: accessing prenatal care later, higher risk pregnancies and less healthy newborns, less breastfeeding, more need for foster care, more single motherhood, and children being born into lives of poverty and lack of opportunity for upward mobility and success.

RESPONSE #3:  The department is driven to optimize the health of Montanans and agrees that Montanans will be healthier as a result of these rule amendments.

COMMENT #4:  One commenter explained that 49% of all pregnancies are unintended and about half of these pregnancies end in abortion.  Preventing unintended pregnancies will reduce the number of abortions.

 RESPONSE #4:  The department agrees that reducing the number of unintended pregnancies should result in fewer abortions.

 COMMENT #5:  The Associate Area Director, Office of Health Care Programs for the Billings Area Indian Health Service commented that Plan First will be beneficial to their population.

 RESPONSE #5:  The department agrees that these rule amendments will be beneficial to all Montanans including Montanans that are Native Americans.


COMMENT #6:  The Department of Public Health and Human Services, Health Resources Division commented that the effective date of these rule amendments should be moved from February 1, 2012 to May 1, 2012 because the approval date of the 1115 Plan First waiver and the enhancements to the claims processing system were not as prompt as anticipated.

 RESPONSE #6:  The department agrees that the effective date of these rule amendments should be May 1, 2012.

COMMENT #7:  The Department of Public Health and Human Services, Child and Family Services Division is requesting that ARM 37.82.701(1)(a) be amended by adding the word "guardianship" to the list of groups covered under Medicaid.  This request is made due to a change in Title IV-E of the Federal Social Security Act that makes these children in Title IV-E guardianships categorically eligible for Medicaid (just as children in foster care and subsidized adoptions have been in the past).  The citation to this federal law is: section 473(b)(3)(C) of the Social Security Act.

 RESPONSE #7:  The department agrees and will make the rule amendment as requested.


            5.  These rule amendments will be effective May 1, 2012.


/s/ John Koch                                               /s/ Hank Hudson for                                               

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                      Public Health and Human Services


Certified to the Secretary of State April 2, 2012


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