Decrease in ER Visits, Hospitalizations with Each Year of Enrollment in Medicaid Expansion

The Montana Healthcare Foundation released its third annual report on the Montana Medicaid program and its impact on the state’s budget, economy, and health. The report found that Medicaid expansion enrollees had fewer visits to the ER each year they were enrolled in Medicaid. This year’s analysis also showed that with these better health outcomes, the healthcare costs for expansion enrollees declined each year they had coverage – and perhaps more importantly, how healthcare spending patterns for enrollees changed over time.

“Medicaid coverage supported more than 60,000 wellness exams, thousands of cancer screenings, preventive dental visits, and other preventive services. In turn, we see declining ER use for common illnesses over years of enrollment. And this year, we also found lower inpatient and ER costs accompanied by higher use of outpatient care and pharmacy over the time people are enrolled in Medicaid. The program is doing exactly what it was designed to do,” said Dr. Aaron Wernham, Montana Healthcare Foundation CEO.

Medicaid provides health coverage for nearly 300,000 low-income Montanans, facilitating access to health services. In 2015, the HELP Act expanded Medicaid to cover nondisabled adults with incomes up to 133% of the federal poverty level. In 2022, approximately 115,000 Montanans were covered by Medicaid expansion.

Key findings with corresponding report pages include:

• Montana spends a lower proportion of its state general fund (13%) on Medicaid than peer states, including some that have not expanded Medicaid.

• Implementing Medicaid expansion generated an estimated state budget savings of more than $27 million in 2022 by providing higher match rates for some existing Medicaid populations and replacing existing state spending with new federal dollars.

• Each year of enrollment, Medicaid expansion enrollees had fewer ER visits and hospitalizations and a decrease in associated healthcare costs.

- The number of people visiting the ER decreased by more than 11% between the first and second years of enrollment.

- The number of people visiting the ER for mental illness or substance use declined by nearly 10% over three years of enrollment.

- Over three years of enrollment, the number of people visiting the ER for preventable dental conditions decreased by nearly 40%.

- Emergency and inpatient costs per enrollee declined by more than 18% over three years of enrollment.

• Health coverage through Medicaid expansion has enabled access to preventive services. In 2021, more than 61,000 expansion enrollees used preventive services, 34,000 received mental health services, and 5,700 received substance use disorder treatment.

• Telehealth utilization increased dramatically during the COVID-19 pandemic and remained high for mental health services through 2021. Nearly 20% of mental health services provided in 2021 were delivered via telehealth.

• Medicaid is a critical source of health coverage for rural Montanans: Nearly two-thirds of enrollees live in rural areas.

• Medicaid expansion provides access to preventive services and treatment to 19,000 American Indian people in Montana and expands health care access for all tribal members.

Medicaid in Montana: How Medicaid Impacts Montana’s State Budget, Economy, and Health was produced by Manatt Health and commissioned by the Montana Healthcare Foundation.