What is Medicaid Expansion? | Healthy Montana Campaign

What's at Stake?

Montanans support our state's Medicaid program, which provides vital care to thousands of Montana residents. An important part of that program is Medicaid expansion, which provides health care to over 80,000 Montanans.

Below, we answer the most pressing questions about what is at stake for health care in Montana.

What does Montana's current Medicaid program look like?

Montana Medicaid covers adults living on very low incomes.
Montana expanded Medicaid coverage in 2015, under the Health and Economic Livelihood Partnership (HELP) Act, to cover low-income adults who previously didn’t qualify for healthcare coverage under traditional Medicaid and who weren’t able to access premium subsidies on the federal marketplace. For the first time, thousands of Montanans were able to afford healthcare.

Currently, 41 states, including Montana, have expanded healthcare coverage under Medicaid, to cover adults ages 19-64, with incomes up to 138 percent of the federal poverty level.

Why does the Legislature have to take action to continue current coverage?

Next session, lawmakers must take action to continue Montana's Medicaid program as is to ensure the continuation of healthcare coverage for over 80,000 Montanans.

After the initial success of expanding Medicaid program, the Montana Legislature voted to renew the program in 2019. However, the 2019 legislation included a termination date. This means is the Legislature must vote to continue the current program before June 30, 2025.

How does Medicaid impact healthcare systems?

Medicaid has benefits beyond improving healthcare coverage for the thousands of Montanans enrolled in the program. The program has helped stabilize Montana’s healthcare system and improved access to treatment for people all across the state.

Medicaid has improved healthcare access not only for people on the program, but for all Montanans. Since 2015, Medicaid has brought in more options for mental health and substance use treatments and other services.

Medicaid has also been an essential support for rural hospitals. Because of Montana's current Medicaid program, rural Montana healthcare hospitals and providers can stay open and keep providing necessary services to their entire community.

How does Montana's current Medicaid program benefit Montanans?

Medicaid provides Montanans with access to life-saving care. Thousands of people have received life-saving cancer or diabetes screenings and have had better access to mental healthcare.

Medicaid helps people during a difficult period in their lives and move to more stability. Most people on stay on the program for a short period of time, and during this time, Montana's Medicaid program makes it easier for people to pay rent, improve their credit, and face financial emergencies.

How does Medicaid impact the state budget?

Montana’s state budget has been boosted by the HELP Act program, which has brought in over $900 million in new federal spending into Montana every year. The federal government pays 90 percent of the costs of coverage for the expanded population, while the state pays only 10 percent.

The HELP Act program generated $27 million in state budget savings in FY 2022 by providing higher match rates for some existing Medicaid populations and by replacing existing state spending with new federal dollars. If Montana were to change its existing Medicaid program, the state would have to pay more for some populations.

How does Montana's Medicaid program impact local businesses?

Montana's current Medicaid program supports businesses, and thousands of working Montanans.

The vast majority (76%) of Montanans on Medicaid work or are in school, with most of the remainder taking care of a family member or living with an illness or disability. In total, 96% work or have a reasonable impediment to work.

Medicaid enrollees work in demanding jobs that are critical to the economy – like childcare, tourism, construction, and agriculture. Additionally, accessing healthcare makes it easier for Montanans living with disabilities or chronic illnesses to find and keep jobs.

Montana's current Medicaid program is especially critical for small and rural businesses and employers by providing health are access. Throughout the state, 6 in 10 Montana employers employ a worker on expanded Medicaid. Medicaid has helped Montana businesses access a healthy workforce.

How does Medicaid support American Indians and Tribal health capacity?

Montana's current Medicaid program has improved access to healthcare across Indian Country. By improving the services IHS and tribal health facilities can offer, the HELP Act program has benefited all American Indian people living on or near reservations, not just Medicaid recipients.

More than 19,000 American Indians were enrolled in expanded Medicaid in 2021. Montana's current Medicaid program has allowed for improved access to preventative services, cancer screenings, mental health services, and substance use disorder treatment.

Because the United States has treaty obligations to provide healthcare in Indian Country, the federal government covers 100 percent of Medicaid services at Indian Health Service (IHS) and tribal health facilities for American Indian Alaska Native members. Montana's current Medicaid program has enabled many IHS and tribal health facilities across the state to move from only being able to offer Level 1, “life or limb” services, to Level 4, preventative services.