Montana
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.
The Montana Lottery offers multiple draw games for those aiming to win big.
Here’s a look at April 19, 2026, results for each game:
Winning Big Sky Bonus numbers from April 19 drawing
05-13-15-17, Bonus: 01
Check Big Sky Bonus payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
When are the Montana Lottery drawings held?
- Powerball: 8:59 p.m. MT on Monday, Wednesday, and Saturday.
- Mega Millions: 9 p.m. MT on Tuesday and Friday.
- Lucky For Life: 8:38 p.m. MT daily.
- Lotto America: 9 p.m. MT on Monday, Wednesday and Saturday.
- Big Sky Bonus: 7:30 p.m. MT daily.
- Powerball Double Play: 8:59 p.m. MT on Monday, Wednesday, and Saturday.
- Montana Cash: 8 p.m. MT on Wednesday and Saturday.
- Millionaire for Life: 9:15 p.m. MT daily.
Missed a draw? Peek at the past week’s winning numbers.
This results page was generated automatically using information from TinBu and a template written and reviewed by a Great Falls Tribune editor. You can send feedback using this form.
The Ole’ Mercantile is a busy place by Grass Range, Montana, standards.
The community of roughly 125 people sits along a long, lonely network of two-lane highways connecting Billings with points north along Montana’s Hi-Line.
For drivers pushing toward Lewistown, Malta or Glasgow, the store’s lights are often the first sign of anything for miles.
Of late, they may also offer a chance of identifying the person driving a truck local women say is stalking these roads.
Owner Krista Manley told Cowboy State Daily her store is outfitted with a top-of-the-line camera system that offers a 360-degree view with no blind spots. Four overlapping cameras capture her property, the Wrangler Bar and the full stretch of Highway 87 frontage running through town.
Fergus County investigators now hope that footage — and Manley’s willingness to comb through hours of it — can help identify the driver of a newer white Ford four-door pickup with dark tinted windows, no front license plate and a chrome grill guard.
The truck is at the center of the most recent reported highway stalking incident.
Lizette Lamb, a 48-year-old traveling health care worker, says she was nearly run off the road the evening of April 10.
Now a growing chorus of similar accounts from women across north-central Montana are popping up on social media.
At The Ole Merc
Travis Lamb, Lizette’s husband, took to Facebook to post about what happened to his wife on one of the loneliest stretches of highway in Montana.
Travis told Cowboy State Daily Lizette pulled into the Ole’ Merc Conoco in Grass Range between 7 and 8 p.m. to grab a drink. She later remembered a pickup was backed in alongside the cafe: a newer white Ford four-door.
“Kind of gave her the heebie-jeebies,” he said. “My wife has worked in a prison and stuff like that, so she’s used to kind of going with her gut.”
She bought a drink, got back in her Ford Bronco Sport and headed north on Highway 19 toward Glasgow.
About a mile and a half down the road, she realized the white pickup was behind her. Through the dark tint, she could make out the silhouettes of two men.
She slowed down and edged toward the shoulder to let them pass. They slowed with her. She sped up. They sped up.
By the time she reached Bohemian Corner 23 miles up the road, Travis Lamb said, his wife knew something was wrong.
There were no other vehicles in the lot, so she didn’t bother pulling in. She tried to call Travis. No service.
She tried 911. The phone beeped, displayed a red message and disconnected.
Truck Gets Aggressive
The white truck continued to shadow Lizette along Highway 191. About two miles from where the road crosses the Missouri River, coming into a construction zone, the pickup got aggressive.
Travis said the truck rode so close to the Bronco’s bumper that his wife could no longer see its windshield, only the grille.
Then it pulled out as if to pass and swerved into her, he said, in what he described as an attempted PIT maneuver — the law-enforcement technique of clipping a fleeing vehicle’s rear quarter to spin it out.
PIT stands for Precision Immobilization Technique, and this tactic is used to stop a fleeing vehicle by forcing it to turn sideways, causing the driver to lose control and stop.
“She was fortunate, kind of timed it to when they went to turn into her and hit her, she sped up,” Travis Lamb said. “And they missed.”
That’s when Lizette Lamb pulled her Springfield XDM 9mm pistol out of the center console. She didn’t point it, but she made sure they could see it.
The white pickup hit its brakes, threw a U-turn in a spray of dust and gravel, and headed back toward Grass Range.
The Video
“I thank God that it did happen to her and not somebody else, because I know my wife is more than capable of defending herself,” said Travis Lamb, an Iraq War combat veteran, who eventually reached out to Manley at the Ole Merc.
Then, when Manley reviewed the surveillance video from the Merc’s camera system, she found no sign of a white Ford truck.
“We have not found evidence of them at our store or at the three businesses that come along the highway right there,” Manley said. “That doesn’t mean it didn’t happen.
“My default is to absolutely believe women, and she (Lizette) was, she was rattled.”
Manley holds a Ph.D. in cognitive psychology and ran the research team at Procore Technologies before going into business for herself.
When reviewing the video, Manley logged the times Lizette arrived and left, and then watched the highway for an hour after.
“We’re absolutely not arguing the authenticity of the report in any way, shape or form,” said Manley. “In my previous life before I had the store, I actually was a memory and cognition researcher. I understand how stress impacts memory.”
The Echoes
Travis Lamb’s Facebook post went off like a flare.
He tallied 36 accounts of similar experiences in roughly the same swath of country stretching across prairie and badlands in one of the least populated parts of Montana.
The pattern in many of the comments was consistent enough to be unsettling: a white pickup, often a Ford, sometimes with out-of-state plates, tailgating women on isolated stretches of two-lane after dark.
One commenter described being followed by a white truck north of Grass Range three years ago around 10 p.m., tailgated with brights on at more than 80 mph until the truck peeled off in a different direction.
Another described a white Ford pickup near Harlowton trying to force her to stop, then waiting for her at a gas station. Another recalled a white pickup with North Dakota plates in the same area.
In Wyoming, one poster described two men in a white truck with Washington plates on Highway 120 between Cody and Meeteetse who tailgated her, tried to push her off the road, then cut in front and slammed on the brakes.
Other women described different vehicles — a dark Escalade, a small white car, a black double-cab — but the same script: tailgating, refusing to pass, brake-checking, dead zones with no cell service.
Easter Night
One name in that Facebook thread was Joni Hartford of Lewistown, who told Cowboy State Daily she had her own near-identical encounter on Easter evening just days before Lizette Lamb’s.
Hartford, who works in insurance, had dropped off some belongings to her son, a football player at Rocky Mountain College in Billings.
She stopped at a gas station on her way out of town “for a pop,” climbed back into her red 2014 Ford F-150 and headed north on Highway 87 around 7:30 or 8 p.m.
“I noticed it right after I left Billings,” Hartford said of the pickup behind her. “It was right behind me and I kept thinking, ‘God, this vehicle is super close.’”
About 15 miles out of town, past the racetracks, she pulled toward the white line and slowed to 60 mph on a long straightaway, hoping the truck would go around. It wouldn’t.
“He was so close behind me, I couldn’t see his taillights, but I could see his marker lamps on his mirrors, his tow mirrors,” Hartford said. “So I knew it was a Ford pickup, and I knew it was like a three-quarter or a 1-ton. It was a big pickup.”
She couldn’t make out the color in the dark. She called her husband.
“I said, ‘This pickup is tailgating me,’ and said, ‘It’s really kind of making me nervous, because if I had to stop for a deer, it would run me over. It would run me off the road,’” Hartford said.
“And he goes, ‘Well, just stop.’ And I said, ‘I am not stopping. I’m in the middle of freaking nowhere,’” she added.
She made it through Roundup with the truck still on her bumper.
North of town, climbing toward Grass Range, Hartford caught a lucky break with an Amish buggy sluggishly clapping up a blind hill and slowing traffic.
“I darted around the Amish buggy, right before the blind hill, and he couldn’t get around them, and I just gunned it, and I was going probably 90 mph just to put space between us,” Hartford said. “I never seen him again.”
Hartford carries a .380 pistol. She had it out and on the seat. She didn’t show it — between the dark and her tinted windows, she wasn’t sure the driver behind her would have seen it anyway.
When Lamb’s post crossed her Facebook feed, Hartford said the parallels stopped her cold.
“It’s the same exact situation,” she said. “I can’t say for certain it was the same person, but it sure seems like it was the same person.”
Hartford said she believes the driver is hunting for circumstance: single women, after dark, on a corridor he knows is desolate and short on cell coverage.
“They’re targeting them at gas stations,” she said. “That’s the only place they could have found me, because it’s the only place I’ve stopped.”
The Candidate
Penny Ronning, cofounder and president of the Yellowstone Human Trafficking Task Force, had a similar drive in 2022.
She remembers it as the only time in nearly a year of solo campaign travel across 41 Montana counties that she felt afraid.
Ronning, then a Democratic candidate for U.S. Congress, was driving from Billings to Havre for a campaign event.
Instead of taking the interstate, she chose the back roads — north out of Winifred on Highway 236, a route that runs about 30 miles of gravel through some of the most remote country in the state before dropping into the Missouri River Breaks, which Ronning compared to a Montana version of the Grand Canyon.
As she entered the gravel, a four-door white pickup with blacked-out windows pulled in behind her.
“That was what made it frightening,” Ronning said. “It was that I was followed.”
Ronning, who has spent years working on human trafficking policy and prevention, was careful to push back on the framing that has circulated on Facebook around the Lamb case — that the white-pickup encounters are likely abduction attempts tied to trafficking networks.
“Human trafficking is the use of force, fraud or coercion to compel a person into commercial sex acts or labor against their will,” Ronning said. “Just because someone is being followed, that doesn’t rise to the level of human trafficking.”
The most prevalent form of human trafficking in the United States, she said, is familial trafficking, one family member trafficking another.
In Montana, she said, labor trafficking is also common in construction, nail salons, illicit massage businesses, hospitality and domestic servitude in pockets of high-end real estate.
Sex trafficking almost always begins with someone the victim knows.
The Watch
Back in Grass Range, every white pickup that rolls past the four-corner blinking light is now turning heads.
Manley said her store has worked closely with the Fergus County Sheriff’s Office on past incidents, and her cameras are essentially a standing resource for investigators.
She also said the response on social media has dismayed her, commenters questioning whether these highway stalking incidents happened at all, or suggesting Grass Range itself isn’t safe.
She believes her store, and others like it in remote pockets of Montana, are informal refuges.
“We’ve all been there, whether it’s in a snowstorm or where we’re just uncomfortable driving like this where we’re just like, ‘Oh my gosh,’ you see the big lights and you’re like, there’s a beacon of safety, essentially,” Manley said.
She said that her eyes are open to potential threats along the isolated highways connecting Grass Range to the rest of the world.
“We know that it is a highway that has a reputation for, you know, trafficking, drug moving, all of those different things, and that’s why we are as diligent as we are,” said Manley. “We really care about the safety of our community, our employees, and our customers.”
Manley remains in contact with the Lambs.
“She told me, ‘I’m not going to quit looking,’” said Travis, explaining how Manley is arranging for the Lambs to review the footage themselves.
Travis figures that perhaps, “Instead of a white Ford, maybe it’s a tan Dodge.”
He added, “I’m hoping somebody’s like, ‘I know that pickup.’ That’s what I’m praying for.”
So is Lizette, who told Cowboy State Daily, she’s thankful for the response to her story. She’s also thankful she was traveling with her sidearm.
“Unfortunately, that’s the world we live in now. You know, Montana, in the middle of nowhere,” said Lizette, who encouraged anyone else with similar encounters to come forward.
“This is just a reminder that it is happening,” she said. “It is real.”
David Madison can be reached at david@cowboystatedaily.com.
The Montana Lottery offers multiple draw games for those aiming to win big.
Here’s a look at April 18, 2026, results for each game:
Winning Powerball numbers from April 18 drawing
24-25-39-46-61, Powerball: 01, Power Play: 5
Check Powerball payouts and previous drawings here.
Winning Lotto America numbers from April 18 drawing
18-21-22-32-42, Star Ball: 10, ASB: 03
Check Lotto America payouts and previous drawings here.
Winning Big Sky Bonus numbers from April 18 drawing
10-16-29-31, Bonus: 13
Check Big Sky Bonus payouts and previous drawings here.
Winning Montana Cash numbers from April 18 drawing
06-08-09-20-22
Check Montana Cash payouts and previous drawings here.
Feeling lucky? Explore the latest lottery news & results
When are the Montana Lottery drawings held?
- Powerball: 8:59 p.m. MT on Monday, Wednesday, and Saturday.
- Mega Millions: 9 p.m. MT on Tuesday and Friday.
- Lucky For Life: 8:38 p.m. MT daily.
- Lotto America: 9 p.m. MT on Monday, Wednesday and Saturday.
- Big Sky Bonus: 7:30 p.m. MT daily.
- Powerball Double Play: 8:59 p.m. MT on Monday, Wednesday, and Saturday.
- Montana Cash: 8 p.m. MT on Wednesday and Saturday.
- Millionaire for Life: 9:15 p.m. MT daily.
Missed a draw? Peek at the past week’s winning numbers.
This results page was generated automatically using information from TinBu and a template written and reviewed by a Great Falls Tribune editor. You can send feedback using this form.
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