New Analyses find Montana's Current Medicaid Program a Critical Source of Coverage

The Montana Healthcare Foundation released three new reports analyzing Montana Medicaid. The reports found that the HELP Act – or “Medicaid expansion” – continues to expand healthcare access, improve health outcomes, and control healthcare costs.

New findings from “2025 Medicaid in Montana” show that in addition to the program’s benefits for the health of enrollees and the state’s economy, Medicaid expansion has had a substantial impact on the healthcare system, particularly in rural areas. Specifically, reimbursement from Medicaid expansion allowed rural health providers to add and expand specialty services, for example, general and orthopedic surgery and mental health treatment. In a survey of 27 Montana critical access hospitals, 93% reported adding or expanding new specialty services since 2016.

“These new specialty services in rural communities benefit all community members, not only those enrolled in Medicaid,” said Dr. Aaron Wernham, Montana Healthcare Foundation CEO. “We also heard from hospital administrators that Medicaid expansion helps rural hospitals support other specialty services essential to communities, but that often operate at a loss, like obstetrics and behavioral health services.”

The reports released today include the fifth annual “Medicaid in Montana” report, an updated analysis of the economic effects of Medicaid expansion, and an actuarial analysis of insurance rates should Medicaid expansion be allowed to sunset in 2025.

Key findings from “2025 Medicaid in Montana: How Montana’s Current Medicaid Program Impacts the State Budget, Economy, and Health” produced by Manatt Health show:

• State expenditures on Medicaid have remained consistent at roughly 13% of Montana’s total general fund spending each year since before the HELP Act was implemented in 2016, despite adding coverage for more than 90,000 Montanans.

• Medicaid expansion improves access to preventive services, contributing to fewer visits to the emergency room and shifting health care costs from emergency and inpatient care to outpatient services and pharmacy. Between their first and third years of enrollment, the number of Medicaid expansion enrollees needing emergency care decreased by almost 11%; emergency and inpatient costs decreased by 18%.

• By providing a new source of reimbursement, Medicaid expansion helps the Indian Health Service stretch its limited budget, improving access to non-emergency health services at no cost to Montana. Between 2015 and 2023, referrals for specialty services unavailable at Indian Health Service or tribal health facilities increased by 124%, allowing access to critically needed services ranging from cancer screenings to specialty consultations and surgeries.

Key findings from “Economic Effects of Medicaid Expansion in Montana: 2025 Update,” produced by economist Bryce Ward of ABMJ Consulting, show:

• Medicaid expansion creates 5,600 to 8,000 jobs and generates $350 to $560 million in personal income throughout Montana’s economy annually.

• Medicaid expansion does not impose a fiscal cost to the state. Savings generated by expansion coupled with increased revenues attributable to expansion more than offset the state’s share of expansion costs.

• Most Medicaid expansion beneficiaries work, and those who do not have caregiving responsibilities or disabilities. 72% of adult Medicaid enrollees are in the labor force or attending school. Another 23% are adults with disabilities or have potential caregiving responsibilities.

• Most working adult Medicaid beneficiaries are employed in low-wage or seasonal industries. Medicaid provides health insurance to 13% of Montana’s workforce. Occupations with high percentages of Medicaid enrollees include personal care aids (39%), cooks and food preparation workers (32%), childcare workers (25%), and construction laborers (20%).

• Medicaid expansion has not reduced adult labor force participation in Montana.

Key findings from “Ending Medicaid Expansion: Effects on the Individual Market,” an actuarial analysis by Wakely Consulting Group, show:

• Should Medicaid expansion be allowed to sunset in 2025, an estimated 54,000 to 74,000 people would lose coverage, increasing the number of uninsured significantly.

• Affordable Care Act individual market premiums would increase by 6% to 8% due to the influx of former Medicaid expansion enrollees into the individual market.

Montana Medicaid is the state’s health benefits program that provides insurance to eligible children and adults with low income. In 2015, the Montana State Legislature expanded Medicaid to cover adults ages 18-64 with incomes up to 133% of the federal poverty level through the bipartisan HELP Act. Of the 268,000 Montanans enrolled in Medicaid in 2024, about 95,000 (or 36%) were covered through the HELP Act.

While Montana’s current Medicaid program has provided health insurance to the expansion population for nearly a decade, this coverage will end unless reauthorized during the 2025 Legislative Session.

To read the reports, visit https://mthf.org/priority/medicaid-and-health-policy.