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What is Medicaid Expansion?

What is Medicaid Expansion?

  • Montana expanded Medicaid coverage in 2015, under the Health and Economic Livelihood Partnership (HELP) Act, to cover low-income adults who didn’t qualify for healthcare coverage under traditional Medicaid and who weren’t able to access premium subsidies on the federal marketplace. 

  • 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 or the first-time thousands of Montanans were able to afford healthcare.

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

  • Next session, lawmakers must take action to renew Medicaid expansion before this date to ensure the continuation of healthcare coverage for 90,000 Montanans.


  • After the initial success of the Medicaid expansion program, the Montana Legislature voted to renew the program in 2019. However, the 2019 legislation included a termination date, which scheduled Medicaid expansion to sunset on June 30, 2025. Montana legislators must vote to renew expansion before this date. 

How has Medicaid Expansion Impacted Healthcare Systems?

  • Medicaid expansion 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.

  • Expansion has improved healthcare access not only for people on Medicaid, but for all Montanans. Medicaid expansion has brought in more options for mental health and substance use treatments and other services. 

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

Most Montanans on Medicaid Expansion Work

How has Medicaid Expansion Benefited Montanans?

  • Medicaid expansion provides 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 expansion helps people during a difficult period in their lives and move to more stability. Most people on Medicaid expansion stay on for a short period of time. Medicaid makes it easier for people to afford healthcare, allowing them to pay rent, improve their credit, and face financial emergencies.

How has Medicaid Expansion Impacted the State Budget?

  • Montana’s state budget is boosted by Medicaid expansion, 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 expansion, while the state pays only 10 percent.  

  • Medicaid expansion 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 expansion were to sunset, the state would pay more for some populations.

How has Medicaid Expansion Impacted Montana Businesses?

  • Medicaid expansion 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 expansion 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.

  • Medicaid expansion 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 Medicaid expansion. Medicaid has helped Montana businesses access a healthy workforce.

How has Medicaid Expansion Supported American Indians and Tribal Health Capacity?

  • Medicaid expansion has improved access to healthcare across Indian Country. By improving the services IHS and tribal health facilities can offer, Medicaid expansion has benefited all American Indian people living on or near reservations, not just Medicaid expansion recipients. 

  • More than 19,000 American Indians were enrolled in Medicaid expansion in 2021. Medicaid expansion 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% of Medicaid expansion services at Indian Health Service (IHS) and tribal health facilities. Medicaid expansion 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.

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