Until this year, most of the ACA exchanges, including HealthCare.Gov, would simply report how many people selected QHPs through the exchange, whether paid up or not. There's nothing wrong with this as long as it's made clear at some point how many people actually paid their premiums and had their policies effectuated; the argument over this issue was the entire basis of the infamous "But how many have PAID???" fuss back in 2014. It was such a Big Deal that the Republicans on the House Energy & Commerce Committee even published the results on a laughably garbage-filled "survey" they had sent out to a portion of the insurance carriers.

(Note In the end, it turned out to be roughly 85-90% depending on the state/carrier in 2014; for 2015 the payment rate nudged up to around 90% overall, which is where it will likely stand going forward).

Long-time readers may have noticed that unlike private QHP enrollment, I've sort of given up on trying to track Medicaid expansion numbers at the state-level on the Medicaid Spreadsheet this year. Quite frankly, there's simply too much missing data and way too much "churn" in Medicaid for me to keep track of it at that granular level. Instead, I've just been looking at the Medicaid numbers from the national level, guided by CMS's monthly reports...but I've proven to be pretty accurate with my proejctions on those trends so far, so I'm not too concerned about it.

However, anytime a new state expands Medicaid, it's big news to track their numbers...and Montana is off to a fantastic start:

Starting Friday, low-income Montanans covered by Montana’s expanded Medicaid program can start using their coverage – and 20,000 people have already signed up.

I know you're not supposed to repost entire articles, but this one is about as short & to the point as it gets. Go visit the Billings Gazette:

HELENA — Montana officials say about 5,500 people have signed up for Medicaid in the first week of expanded eligibility to the working poor.

Department of Health and Human Services Director Richard Opper announced the results of the initial wave of enrollments during a cabinet meeting Tuesday.

An estimated 70,000 people are eligible now that Medicaid has been expanded to people who earn up to 138 percent of the federal poverty level — $33,000 for a family of four.


That's about 8% of Montana's potential Medicaid expansion population in the first week. Not bad!

Just a quick hit here: Federal health officials approve Montana Medicaid waiver

HELENA, Mont. (AP) — Montana will become the 30th state to expand its Medicaid program after federal health officials on Monday approved provisions that include requiring beneficiaries to pay premiums that amount to 2 percent of their income.

Gov. Steve Bullock announced the Centers for Medicare and Medicaid Services' approval of the federal waiver needed for state officials to start enrollment this fall and begin coverage on Jan. 1.

The governor's office has said 70,000 people or more would be eligible for coverage under the expansion, but legislative fiscal analysts predicted about 45,700 would actually participate over the next four years.

Actually, if the past 2 years of Medicaid expansion in the other 29 states are any guide, Montana will probably hit 50-60K easily within the first year. Many other states ended up maxing out by the end of 2014.

I admit that given the carnage of the past couple of weeks, I'm almost afraid to post this entry...but I had to write something positive about the CO-OP situation.

With the ACA-created CO-OPs seemingly dropping like flies due to the #RiskCorridorMassacre, I thought this would be a good time to flip things around and look at which CO-OPs are doing well (or at least not badly).

This isn't much, but it'll do for now:

Wisconsin's insurance department says it has no intention of shutting down its #ACA co-op, which appears it will remain solvent next year.

— Bob Herman (@MHbherman) October 22, 2015

@charles_gaba and at this point, other than Maine, it's difficult to expect many others will last beyond risk corridors.

— Bob Herman (@MHbherman) October 22, 2015

Last month I wrote a quick post about the Montana individual market; with only 3 players, all of whom had requested >10% increases, it was pretty easy to plug the numbers in: 22.2%, 29.3% and 34.0%.

Last week, NBC Montana reported:

Commissioner Monica Lindeen's office says the average rate increase for all plans next year will range between 22 percent and 34 percent. For the popular Silver plan, the increase will range from $80 to $88 a month for a 40-year-old person.

Lindeen said Thursday the rates affect about 41,000 people. They don't include people who receive federal tax credits or those who have insurance through their employers.

The "good" news here is that the affected number is only 41K instead of the 76K I had on record. It's possible that the middle carrier had their rates changed, but overall it looks like the commissioner just signed off on the original requests, for a roughly 26% average increase.

Montana's Dept. of Insurance website doesn't really provide the actual rate filings (or if it does, I can't find them), but it does include this handy chart laying out every carrier offering individual policies in the state (there's only four of them, and one, Assurant, just went belly-up this past spring). That leaves just three companies to track: BCBS of Montana, Montana Health COOP and PacificSource.

Fortunately (well, unfortunately, actually), all 3 of these are listed on Healthcare.Gov's "Rate Review" website, making it fairly easy to generate the weighted average. Sadly, it's grim news in Big Sky country next year:

And Then There Were 21:

Democratic Gov. Steve Bullock signed the Montana Health and Economic Livelihood Partnership (HELP) Act into law Wednesday in the Capitol rotunda as hundreds of people cheered.

The bill was introduced by Republican Sen. Ed Buttrey of Great Falls after lawmakers defeated the governor's expansion proposal.

Buttrey calls the plan the most conservative in the nation due to copays, premiums and other provisions. Because of those items, the state must seek a waiver from the federal government to put the program in place.

Assuming the vast majority of those eligible enroll (which seems to be the case in most states which have gone through with expansion to date), we should be able to chalk up another 35,000 - 70,000 Medicaid expansion enrollees over the rest of the year.

After one botched vote, two years and an all-out resistance blitz by the Koch Bros and their ilk which was so obnoxious that they managed to alienate local Republicans, the Medicaid expansion provision of the Affordable Care Act has finally officially passed both the state House and Senate of Montana, and should be signed into law by the Democratic governor any moment now.

HELENA (AP) – The state Legislature has passed a bill expanding Medicaid eligibility to about 70,000 low-income Montana residents.

The bill approved Saturday heads to Gov. Steve Bullock, who is expected to sign it into law.

I'm back from a short vacation to Chicago (we had a blast, thanks for asking...visited the Shedd Aquarium, Adler Planetarium and Museum of Science & Industry), so obviously my in box has built up quite a bit of ACA news over the past week.

It'll take awhile to sift through everything, but in the meantime there are some state-specific developments which stand out:

MONTANA: A couple of years back, Montana held a vote on the ACA Medicaid expansion provision. It was a tight vote, but should have passed...unfortunately, one state legislator accidentally voted the wrong way on the bill. Seriously:

Some states have declined to expand Medicaid because they oppose Obamacare. Others worry about the financial burden of expanding the entitlement. But there appears to be only one state where the Medicaid expansion failed due to a Democratic legislator accidentally voting against it.

Congratulations, Montana.