Montana

Annual 'Medicaid in Montana' report shows better health, more economic growth • Daily Montanan

Published

11 months ago

January 23, 2025

Annual 'Medicaid in Montana' report shows better health, more economic growth • Daily Montanan

In anticipation of the debate whether to keep Medicaid expansion in Montana, the Montana Healthcare Foundation has released a series of reports it commissioned looking at the impacts of the program on the state’s healthcare, residents and economy.

The annual Medicaid in Montana report has been released annually by the foundation, and this year it highlights a number of key findings throughout the state, including that while the number of people enrolling in the program has decreased — the result of “redetermination” after the COVID-19 emergency — hospitals, including the very small rural ones, have been able to add healthcare services such as orthopedics and behavioral health, an unexpected finding.

The report also found that most of the people covered under Medicaid expansion are in the workforce or a full-time caregiver for a family member. Moreover, the health outcomes and life expectancy have increased, as the average cost per patient decreases over time because the data suggests that healthcare coverage means health issues are addressed earlier and prevented before they become emergency issues.

One other report, commissioned by the Montana Healthcare Foundation and released earlier this month, specifically looked at the economic effects of Medicaid expansion in Montana and was authored by well-known in-state economist Bryce Ward through ABMJ Consulting. That report found that while Medicaid expansion continues to provide access to healthcare, the expansion has accelerated the build-out of Montana’s healthcare system, creating more providers, more jobs and adding as much as $560 million in additional personal income to the economy.

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

More services added

One of the new findings of the yearly study is that Medicaid expansion in Montana has improved the financial health of many critical-care access hospitals and organizations. The reimbursements meant that not as much revenue had to be diverted to cover those residents without insurance.

The report explains that fewer uninsured residents has translated to other services like orthopedics and physical therapy being offered in smaller settings, often closer to home for rural populations. Many systems also reported adding behavioral health services in a state that has a high rate of suicide.

“Medicaid expansion created a new revenue source for Montana’s critical access hospitals, reducing ‘bad debt’ from uninsured individuals and allowing them to invest in hiring new providers and adding service lines that were previously not accessible in more than urban areas,” the annual Medicaid report concluded.

Ward’s report also backed up those findings.

“Before expansion, uncompensated care (uninsured patients) in Montana was equal to 5% of operating expenses,” the report said. “However, it fell to 2% after expansion. In non-expansion states, uncompensated care remained constant.”

Dr. Aaron Wernham, the CEO of the Montana Healthcare Foundation, said expansion has helped the financial picture in a number of ways. New services become available to all patients, not just Medicaid expansion patients, and those services usually have a higher margin, which means they improve the overall financial health of system.

“Those are services that will be available to everyone, whether they’re on Medicaid or not,” Wernham said.

Wernham said that is backed up by another portion of the reports, which focuses on the new healthcare jobs that have been added since Medicaid expansion.

Ward said that Medicaid expansion added $200 million to $300 million to the healthcare economy.

“For instance, Montana has approximately 50 additional primary care physicians and 20 additional dentists due to Medicaid expansion,” the report said.

“That’s an amazing statistic because we’ve been historically underserved,” Wernham said.

New money from the program is flowing into the state, both reports point out.

“Without Medicaid expansion, these dollars would not have been spent in Montana (they would have remained with the federal government),” the report said. “Roughly 75 to 80% of Medicaid expansion spending represents new spending in Montana’s economy.”

Wernham said it’s not just money coming to the state government, it’s money that’s going directly into Montana’s communities, large and small, “to hire people, and those people will need goods and services.”

Who is in the program?

More than one in five Montanans are part of the Medicaid expansion, or 22% of the state population. That number has actually dropped because of the “redetermination” process the state implemented after the COVID-19 pandemic in which those who were enrolled were kept on the program until the conclusion of the health emergency. The effects of that can be seen in the overall numbers. The uninsured population of Montana had been steadily decreasing since expansion in 2015 from 16.4% then to a low of 10.7% in 2021. That number has begun to creep up since redetermination, and now stands at 12%.

In his report, “Economic Effects of Medicaid Expansion in Montana,” economist Ward noted that Medicaid expansion is at its lowest number of enrollees since 2017, when the program was just ramping up. His report points to two possible scenarios.

The first thing that may be effecting the rate of enrollment has been an overall rise in income in Montana, which would lead to better paying jobs, making private insurance affordable, or jobs that offer it as part of a benefit package.

“Income in Montana increased substantially over the past several years. As a result, the number of Montanans with income below 139% of the federal poverty level declined by 11% between 2019 and 2023,” the report said.

However, Ward said it is “unclear” whether that alone provides a complete answer. He said that the challenges experienced by “redetermination,” a process that generated criticism and outrage toward the Montana Department of Public Health and Human Services, could explain some of the drop, too.

“Montana ranks high in both the share of population that reported losing Medicaid coverage (8.4% versus 6.1% percent in the median expansion states) and the share of those who lost coverage and could complete the redetermination process (24.1% versus 15.5% in the median expansion states). Thus two percent of Montana’s population cited the inability to complete the redetermination process as the reason for losing Medicaid,” the report said.

Ward also pointed out that the percentage of people who were classified as “uninsured” also rose at a much higher clip.

“Medicaid enrollment may be artificially low due to redetermination challenges,” the report said.

One of the main concerns expressed by lawmakers is that those covered by Medicaid expansion are not in the workforce. However, the reports found that Medicaid expansion residents are either in the labor force, are in school, disabled, or a caregiver. Only 6% of those covered don’t match one of those descriptions. The 2025 report continues to track data changes year by year, and found that in Montana, 58% spend less than three years on the program.

In the separate report, authored by Ward, the analysis found that “Medicaid expansion does not reduce economic capacity by reducing labor force participation.”

In fact, the labor force participation, especially for the group of people between the ages of 19 and 64, increased from 81% to 83% between 2015 and 2023 — the period of Montana’s expansion.

Ward also studied the types of workers who are in the Medicaid expansion, and found that Montana residents in the services and hospitality, as well as younger workers in a multi-job “gig economy” rely on Medicaid expansion.

For example, the report found that 26% of all Montana’s food preparation and service workers rely on Medicaid and they work an average of 1,448 hours per year at a median hourly wage of $13.59. Other notable categories of employees include personal care employees, recreation and entertainment employees, and farming, fishing and forestry, many of whom work more than full-time, according to the report.

“Since expanding Medicaid, overall adult labor force participation increased in Montana, and the change is almost exactly aligned with the change observed in non-expansion states,” the report said. “This is not consistent with what one would expect if Medicaid expansion was adversely affecting labor force participation.”

Wernham noted that overall Medicaid in Montana covers 13% of the workforce.

“Most of the people in Medicaid expansion are working, and they’re working in sectors that we believe are essential,” Wernham said.

A healthier Montana

The annual study also documented a rise in the number of preventative screenings for diseases like cancer and diabetes, which has also meant that some chronic conditions were detected earlier.

In 2023, more than 52,000 adults went to the dentist for preventative screenings, which represents a 277% increase from the number of dental screenings provided in 2015. Moreover, screening for cholesterol increased by 405% since 2015.

The data suggests that more than 1,400 cases of cancer were averted, with breast cancer and colon cancer the top types. Other categories of care also increased. For example, hypertension treatment has risen by 312% since expansion; diabetes cases treated has risen 245%; and substance use disorder treatment has seen a 636% increase.

Over time, the study tracked the new enrollees’ trips to the emergency room, often the most expensive care available. For patients enrolled in the expansion for more than two years, the 2025 report suggests that there is nearly a 10% drop in need for the services, and over time, that number continues to decrease.

Trips to the emergency room for preventable dental diseases also plunged by nearly 40% for those enrolled for more than three years.

More money to spend

The reports emphasize that because of Medicaid expansion, Montana residents have more money to spend. Ward’s analysis says that Montana households are spending $175 million to $300 million that would have otherwise gone to medical bills.

Not only has Medicaid’s expansion in Montana meant more jobs and more money for other parts of the economy, it has also appeared to have reduced the financial stress on other families as Montana households with medical debt falling from 17% in 2015 to 4% in 2023, according to the report.

“The idea that as many as 80,000 people are now largely free of medical debt — that has a significant impact on the economy,” Wernham said.

More savings for the state

It seems contrary to what someone might expect, Ward’s report said, but Medicaid expansion is actually saving the state money, and not just because the federal government covers as much as 90% of the cost.

Reductions in full Medicaid coverage versus expansion — in other words the number of people who utilize expansion, versus the traditional plan which comes at a much higher state contribution — have meant that more people are covered and yet the State of Montana spends less. Montana’s contributions toward Medicaid expansion, which range from 11% to 13% are still below other comparable states, too.

“Data strongly suggest that the savings within traditional Medicaid offset a substantial portion of the state’s share of expansion costs,” Ward’s report said. “The savings observed in Montana are not unusual; states that expand Medicaid typically experience similar declines in traditional Medicaid costs.

“Legislative Fiscal Division estimates that Medicaid expansion has effectively zero impact on the state general fund,” the report said.

Read the full 2025 Medicaid in Montana Annual report here.

Read the full Medicaid Expansion Economic Impact report here.

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Humane Society of Western Montana has many pets for adoption

Published

12 hours ago

December 19, 2025

Press Room

Humane Society of Western Montana has many pets for adoption

MISSOULA, Mont. — Humane Society of Western Montana’s Director of Marketing Katie Hofschield dropped by NBC Montana Today with special guest Lady Bird.

Lady Bird is a 9-year-old mixed breed who is available for adoption. Lady Bird is house and crate trained and in general is a very laid back dog who loves cheese.

The Humane Society of Western Montana currently has many animals looking for homes, including several older pets, cats, plus two guinea pigs and a rabbit.

The Humane Society of Western Montana runs an annual pet food pantry, but this year they’re expanding into a larger-scale pet food relief project due to holiday and financial pressures on families.

Through a partnership with Greater Good Charities and the Montana Food Bank Network, they received 25 pallets (almost 20,000 pounds) of pet food, which will be stored in a former food bank facility and distributed across the state, including to tribal partners.

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For more information, visit https://myhswm.org/.

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Former Montana Heritage Commission director sentenced in embezzlement scheme

Published

24 hours ago

December 19, 2025

Press Room

Former Montana Heritage Commission director sentenced in embezzlement scheme

Former Montana Heritage Commission Executive Director Michael Elijah Allen was sentenced Thursday to 10-years in the Montana State Prison with seven years suspended for stealing public funds from the state agency charged with preserving some of Montana’s most significant historic sites.

Lewis and Clark County District Court Judge Kathy Seeley said she took no pleasure in imposing the sentence but told Allen he was the brains behind this operation of years of theft and fraud. On a count of theft by embezzlement as part of a common scheme, Seeley sentenced Allen to 10 years at the Montana State Prison with seven years suspended, and imposed a concurrent, fully suspended 14-year term on a felony money laundering count.

“You have destroyed yourself,” Seeley said. “You understand that. I hope you do. This is not anybody but you that did this.”

Allen was ordered to pay $280,000 in restitution to the Montana Heritage Commission, plus a 10% administrative fee, and a series of standard court costs and fees, including a presentence investigation fee and victim-witness surcharge. He received credit for eight days previously served in custody, from Dec. 27, 2024, through Jan. 3, 2025, and was barred from having contact with the Department of Commerce or related entities as he serves his sentence under conditions laid out in a plea agreement.

Prosecutors urged a stiffer punishment, asking the court to impose a 20-year prison sentence with 10 years suspended, arguing that Allen’s years-long scheme was a serious breach of public trust that demanded a lengthy custodial term. Deputy County Attorney Kevin Downs told the court that every defendant in similar embezzlement and financial-crimes cases submitted for comparison had received multi-year prison time and said a 10-year effective prison term was warranted to deter others from stealing public funds.

“He was the one that made this happen. He greased the wheels to steal from people,” Downs said. “This sentence sends a message to people. The people that work in any state agency, god forbid, that if you steal there will be significant consequence.”

Allen’s attorney asked Seeley for a lengthy but largely suspended sentence, arguing that a shorter period of incarceration — about two years, roughly double that imposed on co-defendant Casey Jack Steinke — would still hold Allen accountable while allowing him to work and pay restitution more quickly. The defense said Allen has suffered enough with the public humiliation and collateral consequences, including the loss of his career, voting rights and ability to serve on a jury or possess firearms.

Brenda Elias, chief legal counsel for the Montana Department of Commerce, told the court Allen had been a long-time state employee with significant autonomy as the Heritage Commission’s director and had been compensated for his work. She said Allen abused trust, manipulating people and resources.

“Hundreds of thousands of dollars that should have gone to preserve Montana’s heritage were diverted to Mr. Allen’s personal use,” Elias said.

Elias said Allen served as executive director from 2012 to 2024 and said the Heritage Commission has never been financially self-sufficient, relying heavily on bed tax revenue and other support from the Department of Commerce.

“The Heritage Commission continues to realize the impact of these crimes to this day, and it will take many years for the Commission to recover,” Elias said.

Detective Nathan Casey of the Helena Police Department, a veteran investigator in financial crimes, testified that he was contacted by Commerce employees in mid-2024 after they uncovered significant irregularities, prompting a wide-ranging probe. Casey said investigators ultimately reviewed roughly 744 pages of documents which included invoices, contracts and procurement justifications tied to a state-issued purchasing card controlled by Allen.

According to earlier court records, Allen used his position as head of the Heritage Commission to channel roughly $350,000 in commission funds to Steinke between 2020 and 2024, often through invoices for work that was not legitimately performed. In addition to those payments, investigators found evidence that Allen used public money to cover rent, educational expenses and other personal costs, and that Steinke lived rent-free in Reeder’s Alley, one of the commission’s historic properties, during the scheme.

Steinke, who was charged with accountability for theft by embezzlement and felony money laundering, previously pleaded guilty to one embezzlement-related charge and the money laundering count under a plea deal that called for prosecutors to recommend a 20-year prison sentence with 15 years suspended. As part of that agreement, Steinke agreed to pay $100,000 in restitution, including a $20,000 upfront payment at sentencing.

The embezzlement case comes as the Heritage Commission, which manages historic properties, is facing financial pressure. According to reporting from the Daily Montanan, the Commission is obligated to provide $1.1 million annually to the state but has only generated an average of about $750,000 in recent years, leaving less available for capital improvements than needed to maintain historic buildings.

Allen, 49, told the court he accepted full responsibility for his actions, saying he was ashamed and that the crimes were an aberration from how he had otherwise lived his life. He described the embarrassment his children have faced as his case played out publicly, and said he hopes to work and resume making restitution payments.

“I apologize to my friends and to my community,” Allen said. “I’m incredibly ashamed of the actions.”

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Montana delegation backs bill to release wilderness study areas

Published

1 day ago

December 18, 2025

Press Room

Montana delegation backs bill to release wilderness study areas

Laura Lundquist

(Missoula Current) Most of Montana’s Congressional delegation is once again sponsoring a bill to remove three study areas from consideration as designated wilderness.

On Wednesday, Senators Steve Daines and Tim Sheehy and Rep. Troy Downing reintroduced Daines’ “Montana Sportsmen Conservation Act,” which would remove three wilderness study areas from wilderness consideration, releasing them to be managed as regular federal land. Rep. Ryan Zinke was not listed as a sponsor.

Two areas – the 11,580-acre Wales Creek and the 11,380-acre Hoodoo wilderness study areas managed by the U.S. Bureau of Land Management – are 40 to 50 miles east of Missoula in the Garnet Range north of Interstate 90. The third area, the much larger Middle Fork Judith wilderness study area, is around 81,000 acres managed by the U.S. Forest Service in the Little Belt Mountains southeast of Great Falls.

Daines previously introduced the Montana Sportsmen Conservation Act in 2023, but it was never heard in committee. Now, he’s bringing it forward again, and he explained his strangely titled bill in a press release Wednesday.

“As a lifelong sportsman, increasing access to Montana’s great outdoors is one of my top priorities. The ‘Montana Sportsmen Conservation Act’ promotes our outdoor way of life by returning restrictive WSA’s to general public land management, which will improve wildlife habitat restoration, reduce the risk of catastrophic wildfires, and unlock better access to public land,” Daines said in the release.

It should be noted that neither hunting nor fishing are prohibited in wilderness study areas. In the past, sportsmen’s organizations have opposed the wholesale elimination of wilderness study areas. However, some have indicated they are considering the Wales Creek and Hoodoo areas could serve as political sacrifices to save other areas.

The wildfire risk in the Hoodoo area was significantly reduced this summer after the Windy Rock Fire burned a majority of the area.

Daines first proposed a similar bill – the Protect Public Use of Public Lands Act – in 2018 to release five Forest Service wilderness study areas, including the Middle Fork Judith. Former Rep. Greg Gianforte joined him but increased the number of wilderness study areas on the chopping block to 29, including those under BLM management. Both politicians had based their legislation off feedback from a select group of conservative counties and user groups, including the Montana Stockgrowers Association and the Montana Snowmobile Association. Other organizations protested the bills and the lack of transparency during the process.

This most recent bill is supported by the Montana Logging Association, Montana Snowmobiles Association, Montana Outfitters and Guides Association, Montana Farm Bureau Federation, Great Falls Bicycle Club and the Judith Basin and Powell county commissioners.

In 1976, the BLM established 38 wilderness study areas in Montana, including the Wales Creek and Hoodoo areas. In 1977, the Montana Wilderness Study Act set nine Forest Service study areas aside for wilderness consideration, including the Middle Fork Judith. Federal evaluations of the areas conducted during the 1980s concluded some areas, including the three being considered in the bill, weren’t suitable for wilderness designation.

This year’s bill cites the 2020 BLM Missoula Office Resource Management Plan as justification for eliminating the Wales Creek and Hoodoo wilderness study areas. The plan said the two areas were unsuitable for wilderness designation.

However, the plan was not developed during “a 5-year collaborative process,” as the bill claims, but under the direction of the first Trump administration, which ignored a lot of public comments made during scoping. The three resource management plans for Missoula, Lewistown and Miles City were scheduled to be released to the public in late 2018, but they were delayed when the three offices were required to send the drafts to Washington, D.C., for review and revision. When they were returned and published in May 2019, all three draft plans heavily emphasized natural resources extraction.

A Pew Charitable Trust review of six BLM resource management plans drafted in 2019 found all “would fail to conserve lands that the agency’s own research has deemed worthy of protection; cut decades-old safeguards; minimally protect a fraction of 1% of the areas found to contain wilderness characteristics; and open vast swaths of public lands to energy and mineral development.”

Several Montana conservation organizations protested the Montana plans, including Wild Montana and Backcountry Hunters and Anglers. When the draft plans were finalized in early 2020, some changes had been made to cater to sportsmen, but resource extraction still dominated. The Missoula Office’s new objective was to “produce the greatest quantities of forest products from vegetation restoration activities.”

The 2020 plans created a new designation – backcountry conservation area – that allows resource extraction but prioritizes the long-term maintenance of big game populations for hunting. The Missoula plan proposes to manage its three wilderness study areas as wilderness unless Congress releases them. Then, if Daines’ bill passes, portions of the wilderness study areas would become backcountry conservation areas: a 6,100-acre Hoodoos BCA and a 2,365-acre Wales BCA, according to the plan. The remainder of each area is open to any and all uses.

During the 2025 Legislature, the Senate Energy, Technology, and Federal Relations Committee voted 9-4 against a resolution calling on Congress to remove protection from Montana’s wilderness study areas. More than 3,300 Montanans signed a petition opposing the bill and supporting local solutions for study area management.

Some anticipate that more roads will invade wilderness study areas once they’re no longer protected. Zach Angstead, Wild Montana federal policy director, said Daines has countered those claims by saying the areas will still be protected under the Roadless Rule. But now, the Trump administration is on the verge of repealing the Roadless Rule, so that level of protection could disappear. And Daines strongly supports repeal of the Roadless Rule, according to a Dec. 5 email from a Daines spokesperson to the Flathead Beacon.

“Sen. Daines’ push to remove (wilderness study area) protections and roll back the Roadless Rule show that this isn’t about better local management – it’s about opening Montana’s public lands up to large-scale development to benefit corporations, not Montanans,” Angstead said in a statement. “Managing (wilderness study areas) properly requires local collaborative solutions developed by the people who know these places best. The people and the legislature have made it clear that Daines needs to give up this unpopular crusade to undermine and dismantle public lands and start taking his cues from real people who have been working to shape the future of (wilderness study areas).”

Contact reporter Laura Lundquist at lundquist@missoulacurrent.com.

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