Montana
In Montana, conservative groups see a chance to kill Medicaid expansion • Daily Montanan
Conservative groups are working to undermine support for Montana’s Medicaid expansion in hopes the state will abandon the program. The rollback would be the first in the decade since the Affordable Care Act began allowing states to cover more people with low incomes.
Montana’s expansion, which insures roughly 78,800 people, is set to expire next year unless the legislature and governor opt to renew it. Opponents see a rare opportunity to eliminate Medicaid expansion in one of the 40 states that have approved it.
The Foundation for Government Accountability and Paragon Health Institute, think tanks funded by conservative groups, told Montana lawmakers in September that the program’s enrollment and costs are bloated and that the overloaded system harms access to care for the most vulnerable.
Manatt, a consulting firm that has studied Montana’s Medicaid program for years, then presented legislators with the opposite take, stating that more people have access to critical treatment because of Medicaid expansion. Those who support the program say the conservative groups’ arguments are flawed.
State Rep. Bob Keenan, a Republican who chairs the Health and Human Services Interim Budget Committee, which heard the dueling arguments, said the decision to kill or continue Medicaid expansion “comes down to who believes what.”
The expansion program extends Medicaid coverage to adults with incomes up to 138% of the federal poverty level, or nearly $21,000 a year for a single person. Before, the program was largely reserved for children, people with disabilities, and pregnant women. The federal government covers 90% of the expansion cost while states pick up the rest.
National Medicaid researchers have said Montana is the only state considering shelving its expansion in 2025. Others could follow.
New Hampshire legislators in 2023 extended the state’s expansion for seven years and this year blocked legislation to make it permanent. Utah has provisions to scale back or end its Medicaid expansion program if federal contributions drop.
FGA and Paragon have long argued against Medicaid expansion. Tax records show their funders include some large organizations pushing conservative agendas. That includes the 85 Fund, which is backed by Leonard Leo, a conservative activist best known for his efforts to fill the courts with conservative judges.
The president of Paragon Health Institute is Brian Blase, who served as a special assistant to former President Donald Trump and is a visiting fellow at FGA, which quotes him as praising the organization for its “conservative policy wins” across states. He was also announced in 2019 as a visiting fellow at the Heritage Foundation, which was behind the Project 2025 presidential blueprint, which proposes restricting Medicaid eligibility and benefits.
Paragon spokesperson Anthony Wojtkowiak said its work isn’t directed by any political party or donor. He said Paragon is a nonpartisan nonprofit and responds to policymakers interested in learning more about its analyses.
“In the instance of Montana, Paragon does not have a role in the debate around Medicaid expansion, other than the testimony,” he said.
FGA declined an interview request. As early as last year, the organization began calling on Montana lawmakers to reject reauthorizing the program. It also released a video this year of Montana Republican Rep. Jane Gillette saying the state should allow its expansion to expire.
Gillette requested the FGA and Paragon presentations to state lawmakers, according to Keenan. He said Democratic lawmakers responded by requesting the Manatt presentation.
Manatt’s research was contracted by the Montana Healthcare Foundation, whose mission is to improve the health of Montanans. Its latest report also received support from the state’s hospital association.
The Montana Healthcare Foundation is a funder of KFF Health News, an independent national newsroom that is part of the health information nonprofit KFF.
Bryce Ward, a Montana health economist who studies Medicaid expansion, said some of the antiexpansion arguments don’t add up.
For example, Hayden Dublois, FGA’s data and analytics director, told Montana lawmakers that in 2022 72% of able-bodied adults on Montana’s Medicaid program weren’t working. If that data refers to adults without disabilities, that would come to 97,000 jobless Medicaid enrollees, Ward said. He said that’s just shy of the state’s total population who reported no income at the time, most of whom didn’t qualify for Medicaid.
“It’s simply not plausible,” Ward said.
A Manatt report, citing federal survey data, showed 66% of Montana adults on Medicaid have jobs and an additional 11% attend school.
FGA didn’t respond to a request for its data, which Dublois said in the committee hearing came through a state records request.
Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, also declined to comment. As of late October, a KFF Health News records request for the data the state provided FGA was pending.
In his presentation before Montana lawmakers, Blase said the most vulnerable people on Medicaid are worse off due to expansion as resources pool toward new enrollees.
“Some people got more medical care; some people got less medical care,” Blase said.
Reports released by the state show its standard monthly reimbursement per Medicaid enrollee remained relatively flat for seniors and adults who are blind or have disabilities.
Drew Gonshorowski, a researcher with Paragon, cited data from a federal Medicaid commission that shows that, overall, states spend more on adults who qualified through the expansion programs than they do on others on Medicaid. That data also shows states spend more on seniors and people with disabilities than on the broader adult population insured by Medicaid, which is also true in Montana.
Nationally, states with expansions spend more money on people enrolled in Medicaid across eligibility groups compared with nonexpansion states, according to a KFF report.
Zoe Barnard, a senior adviser for Manatt who worked for Montana’s health department for nearly 10 years, said not only has the state’s uninsured rate dropped by 30% since it expanded Medicaid, but also some specialty services have grown as more people access care.
FGA has long lobbied nonexpansion states, including Texas, Kansas, and Mississippi, to leave Medicaid expansion alone. In February, an FGA representative testified in support of an Idaho bill that included an expansion repeal trigger if the state couldn’t meet a set of rules, including instituting work requirements and capping enrollment. The bill failed.
Paragon produced an analysis titled “Resisting the Wave of Medicaid Expansion,” and Blase testified to Texas lawmakers this year on the value of continuing to keep expansion out of the Lone Star State.
On the federal level, Paragon recently proposed a Medicaid overhaul plan to phase out the federal 90% matching rate for expansion enrollees, among other changes to cut spending. The left-leaning Center on Budget and Policy Priorities has countered that such ideas would leave more people without care.
In Montana, Republicans are defending a supermajority they didn’t have when a bipartisan group passed the expansion in 2015 and renewed it in 2019. Also unlike before, there’s now a Republican in the governor’s office. Gov. Greg Gianforte is up for reelection and has said the safety net is important but shouldn’t get too big.
Keenan, the Republican lawmaker, predicted the expansion debate won’t be clear-cut when legislators convene in January.
“Medicaid expansion is not a yes or no. It’s going to be a negotiated decision,” he said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism.
Montana
Montana State doctoral student awarded national research service grant for gut microbiome, arsenic research
MISSOULA — Four out of five members of Montana’s Public Service Commission were in a federal courtroom in Missoula Thursday morning, as the PSC’s former president challenges the disciplinary action taken against him earlier this year. Now, newly released documents are shedding more light on to what led up to this point.
(Watch the video for a closer look at the case.)
New documents shed light Montana PSC dispute
Commissioner Brad Molnar has sued President Jeff Welborn, Vice President Jennifer Fielder and Commissioner Annie Bukacek – the three PSC members who voted in May to require him to work remotely, after an investigation into complaints about his workplace conduct. Molnar has claimed he is being unfairly punished for constitutionally protected speech, and he asked Senior U.S District Judge Donald Molloy to allow him to return to the PSC offices.
Matthew Monforton, Molnar’s attorney, told the judge that barring Molnar from the building was limiting his ability to do his job.
“He has not been officially kicked out of office, but his voice has clearly been diminished,” said Monforton.
But Natasha Jones, an attorney representing the other three commissioners, said the findings were about behavior, not just speech, and that the PSC’s action was a reasonable response.
“These are serious concerns about a pattern of conduct that has made employees quit,” she said.
Jonathon Ambarian
On Tuesday, Molloy ordered the release of redacted versions of two full investigative reports into Molnar’s conduct – more than 100 pages of documents. Monforton had moved for the full reports to be made public, and Molloy ruled attorneys for the other PSC members hadn’t shown a compelling reason to keep the documents under seal as long as the names of people involved in the investigation were obscured.
While the names remained redacted in the investigation reports, the attorneys for Welborn, Fielder and Bukacek also filed additional documents – including a public declaration from Bukacek and from former PSC executive director Alana Lake, providing information about their allegations against Molnar.
The two reports, from an outside investigator, cover Molnar’s alleged actions over two periods: the first from February to August 2025, and the second from August to October 2025. The investigation began after the first formal complaint, filed by Bukacek in May 2025 – though the reports say employees had been bringing up concerns about Molnar’s behavior informally for several months prior.
Bukacek’s complaint claimed Molnar had repeatedly made what she called “sexualized and demeaning comments.” The examples she cited included saying the PSC should replace “Taco Tuesdays” with “Topless Tuesdays,” reminiscing about watching girls in bikinis as a teenager, and commenting about the beauty of women in areas of China who didn’t get “old and wrinkly.”
In her declaration, Bukacek also claimed Molnar had “maliciously disseminated false information” about her and “engaged in behavior that was dismissive, derisive and otherwise abusive.”
“My primary concern now is not for my safety nor my feelings, but for the rest of the staff who may not have the temperament to speak up or may feel too intimidated to speak up given concerns over job security,” Bukacek said in her declaration.
MTN News
The investigators determined Molnar had violated the PSC’s code of conduct by making comments of a sexual nature, and that it appeared his behavior had continued for some time after he was warned about it. They also found he had behaved unprofessionally and in a belittling manner toward Bukacek, though they said Bukacek herself had at times used “language that could be considered inappropriate” in emails to staff or other commissioners. Bukacek told MTN she “readily self corrected” any behaviors that were brought to her attention.
The investigation also found a violation in connection with a complaint from a PSC staff member, who said he “felt bullied” by Molnar when the commissioner sent an email complaining about his team not being “people with competence.”
However, much of the first report and the entire second report was focused on conduct after the initial complaints, when Molnar was accused of retaliating against people who participated in the investigation. Lake said in her declaration that she saw “an immediate and significant change in his behavior toward staff involved in the process.” She claimed he said he would use an attorney and private investigator to go after people who filed complaints, and she accused him of publicly criticizing her in interviews and removing her job responsibilities because of her handling of the investigation.
Lake said Molnar’s actions led to “declining morale within the agency,” undermined staff members’ ability to do their jobs and damaged her reputation. She said that led her to resign as executive director.
“I believe no employee should be forced to choose between reporting misconduct and protecting their career, reputation, or personal well-being,” she said in her declaration.
Lake has since become Helena city manager.
Jonathon Ambarian
The report said there was evidence to show Molnar had retaliated, including by “making disparaging statements about investigation participants” including Lake, by sending an email warning he could file complaints of his own against people involved, and by taking other actions investigators said could dissuade employees from reporting behavior in the future.
Monforton said during Thursday’s hearing that the initial comments Bukacek complained about were jokes Molnar had admitted were inappropriate, that he regretted saying them, and that he hasn’t made any similar comments in about a year. But he argued the vast majority of the findings against Molnar were about retaliation – and that those were primarily based on speech that the other commissioners don’t have the right to interfere with.
Monforton said it’s unreasonable to punish Molnar for what he said in the July news conference where he announced he was under investigation, in interviews with the media or in commission meetings. He said Molnar’s conduct doesn’t rise to the level of actual retaliation.
“This is an elected official, engaging in speech in his forum,” Monforton said.
He said Molnar may have made harsh comments toward staff, but that he had the right to raise objections about the way the agency does business.
Jonathon Ambarian
Monforton also argued the retaliation claims no longer justify keeping Molnar out of the office, since Welborn, Fielder and Bukacek voted to remove him as president in October and he no longer has the authority he’s accused of misusing. He said there haven’t been further complaints about his behavior since that time.
“We’re not asking for the moon and stars, we’re asking for the status quo as it existed for the last seven months,” he said.
Jones said there is enough evidence to show Molnar would have been punished regardless of whether any protected speech was excluded.
“This is not about a couple of jokes,” she said.
Jones said Molnar made maliciously false statements about people like Lake, and that type of statement isn’t covered by free speech protections.
She also said Molnar’s exclusion from the PSC offices is temporary, and that the PSC will reconsider whether to let him return if he apologizes for his actions, accepts the agency’s code of conduct and undergoes training.
Molloy indicated he saw indications that there was “acrimony” on both sides of the situation, and said he was skeptical it would be resolved easily.
“It would be nice if instead of juvenile behavior, there was professional behavior,” he said.
However, the judge said there was an avenue for Molnar to pursue if he wanted to reach a resolution.
Molloy took no immediate action Thursday. He told the parties he would rule as quickly as he could.
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