Montana Medicaid is good for our state and 85% of Montanans support keeping the program as it is today. Unfortunately, organizations from outside of Montana have been distorting the program, spreading misinformation and making things political. This program is too important for the people of Montana to play politics, which is why and it’s so important to understand the facts about Medicaid in Montana.
The Truth About Medicaid in Montana
The truth is this:
The Claim:
If the federal government cuts funding, Montana will be on the hook for the whole cost of the current Montana Medicaid expansion program.
The Truth:
The federal government currently pays 90% of the costs associated with Montana’s current Medicaid program.
If the federal government were to stop its Medicaid payments or reduce its share of the costs, the state of Montana would not be on the hook for the full cost of the program.
Current Montana law includes a “trigger” mechanism that if the federal government changes their funding formula, any additional state funding for the Medicaid program would require approval of the state legislature.
If the current Medicaid program were to expire, however, Montana would lose federal healthcare funding for almost 80,000 Montanans, and would lose out on the more than $1 billion in non-state money currently supporting healthcare services for all of us in Montana.
The Claim:
The Montana Medicaid program is costing Montana too much money and drawing funds away from other critical programs and services.
The Truth:
This is an untrue claim made by out-of-state interest groups. The state and federal governments jointly fund Montana’s Medicaid program, with federal dollars covering 90% of expenditures and state funds covering just 10% for those enrolled under expanded eligibility through the current Montana Medicaid program.
The percentage of Montana State General Fund spending on Medicaid was stable at around 13% of the state budget from 2015 through 2022 and dropped to only 11% of the budget in 2023
In 2023, Montana spent just $68 million on those who qualify for Medicaid under the current program, while receiving more than $1 billion in non-state money to help cover the cost of needed care for these Montanans.
If the current Montana Medicaid program were to be changed or allowed to expire, the state would forfeit the 90% subsidy currently being paid by the federal government and be forced to take on the financial burden of providing care for the nearly 80,000 people who would lose their health coverage.
The Montana Medicaid program doesn’t divert funds from other state budget priorities. However, ending the program would. Without Medicaid, the state would have to spend an extra $26 million to close its budget gap from losing these federal funds. That would require a tax increase, reduction in services, and/or pulling funds from other state priorities.
The Claim:
If Montana’s current Medicaid program isn’t renewed, enrollees can just get different health coverage on the exchange.
The Truth:
Buying health coverage on the Affordable Care Act marketplace would not be an option for most Montanans currently enrolled with today’s Medicaid program.
Without Montana’s current Medicaid program, as many as 67,000 people in our state would fall into the “coverage gap” – earning too much to qualify for traditional Medicaid while not earning enough to quality for subsidies on the marketplace5. Montana’s current Medicaid program helps bridge this gap by allowing hardworking, low-income Montanans earning up to 133% of the Federal Poverty Level to access Medicaid coverage.
The Claim:
Ending the current Medicaid program wouldn’t have any effect on Montanans who are covered by private insurance plans, only those who were on Medicaid.
The Truth:
Making more people eligible through the current Medicaid program has helped reduce the state’s uninsured rate, stabilized rural healthcare providers and expanded services for mental health and substance abuse disorders, providing greater access for all Montanans.
Ending the current Medicaid program would reduce provider revenue, increase provider closures, and increase mortality rates.
While the exact numbers are difficult to forecast, a 2024 actuarial analysis concluded that individual market premiums would be 6% to 8% higher for marketplace participants if Medicaid expires.
The Claim:
Medicaid incentivizes people not to work or look for a job.
The Truth:
The Montana Department of Labor and Industry reports that more than three-quarters (76%) of Montana’s adult Medicaid enrollees are employed or attending school. The majority of the rest of Medicaid recipients are either caretakers or have a disability or other condition that prevents them from working.
In order to qualify for extended coverage under the current Montana Medicaid program, individuals and families must have an income between 25% and 138% of the federal poverty level. This means those receiving Medicaid coverage must be earning money—and contributing to the state’s economy.
The Claim:
Expanded coverage under Medicaid is not supported by Montanans.
The Truth:
This is completely false. Montanans overwhelmingly support continued expanded coverage under the current Montana Medicaid program.
A recent poll conducted by the Montana Chamber of Commerce shows 85% support keeping the Montana Medicaid program as it is today. The data is extremely clear: Montanans want people to have access to health coverage and any effort to take it away would defy voters’ wishes.
”“There’s a lot of people who are working and they still need Medicaid. You’d be surprised at how many are in a similar situation I was in. They just need help to get back on their own two feet.”
Charlotte JeffersonFormer Montana Medicaid Participant
The Claim:
People are abusing the system to get free care paid for by taxpayers.
The Truth:
Medicaid provides health coverage for people when they need it most — during times of job transition and financial difficulty. Among those who have coverage through the program, the average length of enrollment is less than 24 months. This indicates that people are working to pull themselves out of poverty and create a better situation for themselves and their families.
The current Montana Medicaid program helps people whose incomes are not low enough to qualify under traditional Medicaid coverage rules and are too high to qualify for subsidized coverage on the exchange. This program is not giving handouts to people who refuse to work — it is a vital lifeline for the working poor who are doing all they can to get by but happen to fall into the coverage gap through no fault of their own. These people are mothers, fathers and caregivers — members of our communities. Providing health coverage doesn’t pay their bills; it protects them from financial calamity. When they’re sick, it helps them get back to work and return to normal life faster.
Breakdown of Montana Medicaid Enrollees
72% are working
10% are ill or disabled
7% are caregivers for family
4% are attending school
4% retired or other
3% could not find work
The Claim:
The Montana Medicaid program is bad for Montana’s economy.
The Truth:
The current Montana Medicaid program supports job growth, personal spending and economic growth throughout the state. In 2022, Montana Medicaid’s extended coverage helped create:
- Up to 8,000 jobs across multiple industries.
- Up to $560 million in personal income, which in turn is reinvested and spent at local businesses.
”“Montana Medicaid has had a remarkably positive impact on our state’s businesses and economy. From adding jobs and improving the health of our workforce, to reducing healthcare costs for employers and saving Montana taxpayers money, the current program has ripple effects that benefit all Montanans.”
Todd O’HairPresident & CEO, Montana Chamber of Commerce
The Claim:
Medicaid isn’t making any real difference for Montana hospitals.
The Truth:
Since the current Medicaid rules were put in place in 2015, no rural hospitals in Montana have closed. Uncompensated care at Montana hospitals has been reduced by $225 million per year.
In a survey of 27 Montana critical access hospitals, 25 (93%) reported adding and/or expanding new specialty services since 2016, including behavioral health services. This benefits everyone in Montana’s rural communities, not just those enrolled in Medicaid.
The Claim:
The Montana Medicaid program has supported and increased taxpayer-funded abortions.
The Truth:
This is false. Expanded coverage under Medicaid has had no impact on abortion services in Montana. The Hyde Amendment prohibits the use of federal funds to pay for abortions, except in some very limited cases. Instead, abortion services for those receiving Medicaid are paid for by state general funds but are subject to extremely narrow parameters including cases of rape, incest or when an abortion is deemed medically necessary to save the life of the mother. It is important to note that hospitals in Montana do not provide elective abortion procedures, and there are very few providers in the state that do. Neither state nor federal funds may be used for elective abortion procedures.
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