Montana
Medicaid Expansion Debate Will Affect Other Health Policy Issues Before Montana Legislature – Flathead Beacon
HELENA – A last-minute change to a 2019 bill put an end date on Montana’s Medicaid expansion program, setting the stage for what is anticipated to be the most significant health care debate of the 2025 Montana Legislature.
In recent interviews, legislative leaders predicted a vigorous debate over keeping the Medicaid expansion program, which pays the medical bills of more than 75,000 low-income Montanans at an annual cost of about $1 billion to the federal and state governments. They also expect the topic to seep into other health policy decisions, such as the approval of new spending on Montana’s behavioral health system and regulation of hospital tax-exempt status.
“It all kind of links together,” said state Sen. Dennis Lenz, a Billings Republican and chair of the Senate Public Health, Welfare, and Safety Committee.
Legislators from both parties also expect lawmakers from the GOP majority to continue to pursue abortion restrictions, despite a November statewide vote making abortion a right under the Montana Constitution.
The Medicaid expansion debate, however, looms largest among the health care topics.
“This is definitely the elephant in the room, so to speak,” said Senate Minority Leader Pat Flowers, a Belgrade Democrat.
Montana expanded Medicaid, initially for four years, in 2015, through a coalition of minority Democrats, some moderate Republicans, and a Democratic governor. A similar coalition renewed the program in 2019, but at the last moment, Senate Republicans tacked on an end date of June 30, 2025. That put the matter in the lap of this year’s legislature.
Republicans still hold strong majorities in the state House and Senate, whose leaders voiced concerns about the expansion program.
This time around, the governor — Greg Gianforte — is a Republican. Last year, the Gianforte administration completed a postpandemic eligibility reassessment that cut the number of expansion enrollees from a high of 125,000 people in April and May 2023 to approximately 76,600 people as of October, the most recent data available.
Gianforte has included funding for Medicaid expansion in his proposed budget, which must be approved by the legislature to take effect. His office said he wants “strong work requirements for able-bodied adults without dependents” to take part in the program. Spokesperson Kaitlin Price said the governor “has been clear that the safety net of Medicaid should be there for those who truly need it, but that it will collapse if all are allowed to climb on it.”
GOP legislative leaders clearly are skeptical of the program, saying it won’t continue without some “sideboards,” or additional requirements of enrollees and providers.
Whether any expansion bill passes “will depend on the people pushing it,” said Senate President Matt Regier, a Kalispell Republican who opposes expansion. “If there is no give-and-take, it could be an interesting vote.”
Flowers said he knows getting Medicaid expansion through the Senate will be tough. Republicans hold a 32-18 majority, and the GOP caucus leans conservative.
“There are a lot of my colleagues on the Republican side that are ideologically opposed, and I think you’re going to see that in their consistent voting against reauthorizing,” Flowers said.
Medicaid, funded by both the state and federal governments, provides health coverage for certain groups of low-income people. Expansion extended Medicaid coverage to nondisabled adults ages 19 to 64 with incomes up to 138% of the federal poverty level — about $20,800 a year for an individual in 2024.
The 2010 federal Affordable Care Act opened Medicaid to this new group of adults, starting in 2014. But a 2012 U.S. Supreme Court ruling said states could choose whether to adopt the change, and 40 have done so.
Republican state Rep. Ed Buttrey said he would sponsor a bill to reauthorize Medicaid expansion without an expiration date, but many GOP lawmakers remain unconvinced that expansion is needed, viewing it as a costly, unnecessary welfare program.
“I understand there are some pros to Medicaid expansion, but, as a conservative, I do have issues with — I guess I can’t get around it — socialized medicine,” said House Speaker Brandon Ler (R-Savage).
In September, representatives from a pair of conservative-funded think tanks made a case for ending Medicaid expansion, saying its enrollment and costs are bloated. The consulting firm Manatt, on the other hand, said more people have access to critical treatment because of Medicaid expansion.
At the least, it appears many Republicans want to require participants to work, pay premiums, or meet other conditions, if the program is to continue.
Premiums and work requirements are in Montana’s law right now. The Biden administration, though, nixed both, so they haven’t been in effect. Montana Republicans expect the incoming Trump administration to be more open to such provisions.
Democrats say Medicaid expansion has succeeded on many fronts: covering thousands of low-income workers, helping keep rural health care providers and hospitals afloat, and bringing hundreds of millions of federal dollars into Montana’s economy. The state pays 10% of the program’s costs, which totaled about $962.4 million in fiscal year 2024. The federal government picked up $870 million of that tab.
“With all that, it’s just stunning to me that there could be opposition,” Flowers said. “There is just no reason for us, collectively as a state, not to support this.”
Democrats will have their own expansion bill, brought by Rep. Mary Caferro of Helena. She said the bill would remove the work requirements and premiums, shine more light on the contracting activities of the state health department, and reopen some public assistance offices that have been closed. It also would make expansion permanent.
“We’re 10 years into this program,” said Rep. SJ Howell of Missoula, the Democratic vice chair of the House Human Services Committee, which debates health policy legislation. “I think that continuing a cycle of uncertainty for patients and providers doesn’t make sense.”
Legislators also see the expansion debate tying into other health care discussions.
Regier and Lenz said Montana’s nonprofit hospitals — strong supporters of expansion — have benefited greatly from the program and may need to give something back in return. One possibility: more government oversight of the “community benefits” that hospitals must provide to receive tax-exempt status.
They also noted that Montanans pay a fee for hospital stays to support the Medicaid program and that a fee on hospital outpatient revenue helps pay the costs of Medicaid expansion. Those fees and the resulting money raised for hospitals may merit review, they said.
Meanwhile, backers said Medicaid expansion underpins one of the governor’s major policy priorities, to improve the state’s behavioral health system. Gianforte has proposed spending up to $100 million over the next two years on 10 recommendations made by an advisory commission that reviewed the system for the past 18 months.
If Medicaid expansion ends, many adults would lose access to the mental health and addiction treatment system that Gianforte wants to improve, advocates said, while treatment providers would lose a significant source of revenue.
Money for the behavioral health changes would come, in part, from a $300 million fund created by the 2023 legislature. Lawmakers plan to scrutinize Gianforte’s proposals during the budgeting process. Howell said Democrats want to look at whether the changes would use enough of the $300 million fund quickly enough and on the most pressing needs.
Meanwhile, Republicans said they’ll likely introduce bills on abortion — even though Montanans approved Constitutional Initiative 128 by a 58-42 margin in November. CI-128 said the right to an abortion cannot be “denied or burdened” except by a “compelling government interest achieved by the least restrictive means.”
“It’s not going to slow us down in our pro-life positions,” Ler said of CI-128.
At a minimum, GOP leaders said, some of CI-128’s terms should be defined.
“With a very poorly written ballot initiative like that, we need to say, ‘What does that abortion industry look like under CI-128 and what’s our role as a state?’” Regier said.
But state Sen. Cora Neumann, a Bozeman Democrat on the Senate Public Health, Welfare, and Safety Committee, said the CI-128 vote provided a strong mandate for the right of privacy.
Enacting restrictions would lead to “that slippery slope of what’s next, if we allow legislators to rule on what’s happening in the doctor’s office,” she said. “What kind of can of worms could be opened to other invasions of privacy?”
Montana
Montana cowboys help build trauma ranch for Israeli soldiers
The hills of the northern Judean Desert will soon turn yellow and dry. For now, they are covered in green bloom, dotted with bursts of purple and yellow wildflowers, butterflies hovering above them. From a hilltop in the Binyamin region, where Ruthy and Haim Mann run their therapeutic horse ranch, the view opens wide: the Moab Mountains to the east, the Binyamin hills to the north, Wadi Qelt plunging dramatically toward the Jordan Valley and the northern Dead Sea. At moments, when the haze lifts, Herod’s winter palace can be seen in the distance on the other side of the wadi.
Biblical history feels at home here. Philistines and Crusaders, Babylonians and Hasmoneans, Assyrians, Byzantines and Seleucids all passed through. Joshua, Saul and Jonathan fought nearby. David hid in these hills. On one of the mountains opposite us, the Good Samaritan once passed, refusing to ignore a wounded man lying by the roadside and bandaging his injuries.
The desert has seen much. But a band of real-life cowboys from Montana, pointed boots, wide-brimmed hats and oversized belt buckles, is new even for this landscape. But a band of cowboys who wear Tzitzit (fringed ritual garment), bless bread with the Hebrew “hamotzi,” keep Shabbat and study the weekly Torah portion, though they are devout Christians, is new for me as well.
They define themselves as Christian Zionists. Not an official denomination, more a small, independent current on the margins. They have no church of their own. “But it’s growing,” said Zach Strain.
When I ask Yoss, short for Yosef, Strain and Jedidiah Ellis why they wear blue Tzitzit attached to their belts, Yoss quotes the Book of Numbers, Chapter 15, Verse 39. “That’s the longest I’ve heard him speak since they got here,” Haim Mann jokes.
4 View gallery
Ruthy and Haim Mann, the ranch owners
(Photo: Alex Kolomoisky)
On a recent Monday morning, the small group of five men and three women is already at work. Bethany Strain and Lily Plucker haul wheelbarrows of stones, Lily’s three-month-old son, Jethro, strapped to her chest. Her husband, John Plucker, the group’s unofficial leader, builds the wooden ceiling of what will soon become a resilience and support center for soldiers coping with PTSD at the edge of the ranch.
Yoss and Jedidiah work on the stone wall of the riding arena. Promise Strain washes laundry by hand facing the desert view. Eliora Ellis saws a wooden beam. Zach, who stands nearly 6-foot-7, reinforces the stable fence. They work in near silence, focused, as if fulfilling a commandment.
By profession, Zach trains horses and riders for the film industry, primarily for Westerns, and has appeared in some of them himself. He worked on the TV series “Yellowstone.” When I try to draw him into Hollywood gossip about Kevin Costner, but since there is a biblical injunction against gossip, all I can get out of him is that the horses on the series were the finest and most expensive available. They are reserved, almost shy. They speak sparingly. They appear unaccustomed to social company. Montana is about 18 times the size of Israel with roughly one-tenth its population. The nearest neighbor can be miles away. In the photos they show me, each home looks like it could have stepped straight out of the cast of “Little House on the Prairie”, except for one detail: a giant Star of David mounted on the Strain family home.
All of them are related. Zach, Yoss and Promise Strain are siblings (the fourth brother, Ezekiel, left yesterday). Jedidiah and Eliora are married. Yoss is married to Bethany, John Plucker’s sister. Plucker is married to Lily. It is their last day in Israel, and they seem determined, more than anything, to make the most of every remaining moment. This is their last day, though not their first visit. For most of them, it is their fourth or fifth trip, and never a vacation. They come to work.
Ruthy and Haim Mann, the ranch owners, are Israeli cowboys in their own right. Boots, hats and wide brims included. Haim, a lawyer by training, also carries a handgun. They live in the settlement of Alon, part of a cluster of three Jewish communities northeast of Jerusalem, which includes mixed, religious and secular residents living side by side. “It works beautifully,” Haim says. The population is largely middle-class.
Indeed, although several flashpoints of the Israeli-Palestinian conflict, including Khan al-Ahmar, lie not far from here, this specific area, located in Area C of the West Bank, is quiet and calm. Not quite Montana, but they manage with what they have.
4 View gallery
Riding against the backdrop of the new treatment center
(Photo: Alex Kolomoisky)
Both are remarried. Together they have two daughters, along with four children from Haim’s previous marriage and two from Ruthy’s, and they are grandparents to five grandchildren. Thirteen years ago, they founded a small therapeutic horse ranch. (“We’ve always loved horses,” they say). Ruthy handles treatment, working with teens with autism, motor and social challenges and trauma. Haim manages the horses. Five years ago, they were told to evacuate their original site. “We gave service to the whole community and got a punch in the stomach in return,” Ruthy said. With assistance from the Settlement Division, they relocated to the current hilltop. Haim closed his law office, Ruthy left her job at the Biblical Zoo in Jerusalem, and they committed fully to the ranch, which officially opened to the public about six months ago. Five dunams, 13 horses and a sweeping biblical landscape. Beyond routine therapy for local youth, the ranch increasingly served teens who had left the ultra-Orthodox community, including girls who were victims of sexual abuse, “even at ages 12 and 13”, sometimes within their own families.
About two years ago, they began hosting a joint Passover Seder for dozens of such teens. “The at-risk girls,” Ruthy says, “taught us a great deal about treating trauma.” That knowledge, regrettably, soon became urgently necessary. When war broke out after the October 7’s Hamas massacre, activity at the ranch halted. Ruthy began treating evacuees from southern Israel housed in Dead Sea hotels. “Everything there was terrible,” she says. At first, the therapy sessions were held in the hotels, without horses, using smaller animals instead. Over time, families began coming to the ranch to ride. “We started with 20 families. Within a month, 150 were coming,” she said.
Soon after, soldiers began arriving, some physically wounded, others psychologically scarred. “It started with soldiers who rode with us as kids,” Haim said. “They enlisted, went to fight and were injured. They came back to us to rehabilitate, to regain control over their lives.”
The need, they say, is immense while the supply is limited. Many soldiers from the West Bank have been killed or wounded, disproportionately to their share of the population. “But in all of the West Bank,” Ruthy says, “there isn’t a single ranch like this. There is a resilience center in Binyamin, but not everyone is suited to sitting in a closed room talking to a therapist about their feelings. It’s also a community that is less inclined to ask for help. Still, many people need precisely this kind of therapy, with horses, out in nature.”
4 View gallery
Building a wooden ceiling on their last day in Israel
(Photo: Alex Kolomoisky)
Demand is surging. “We feel the shockwaves of the psychological injuries from the war starting to hit with tremendous force,” Ruthy said. “It’s not just ripples. It’s a tsunami.” Everything mental health experts warned about during the war, that once it ended and there was no longer anything to suppress or conserve strength for, a major wave of psychological casualties would follow, is unfolding before the Manns’ eyes. “You feel it everywhere,” Haim adds. “In rising divorce rates, in pent-up violence. We know that what isn’t treated today will worsen tomorrow. The country has to confront this by building more resilience centers, otherwise we’ll be carrying it for years. “And it’s not like the trauma of October 7 is going to disappear anytime soon. We’ll be living with it for years.”
“There are other injuries that aren’t being talked about enough,” Ruthy says. “For instance, girls who were already in very difficult circumstances before October 7 and had just started to rebuild their lives, only for the war to shift attention elsewhere and leave them sidelined.” There are also many patients with older wounds and traumas that resurfaced, but there isn’t enough time, enough therapists or enough resources to reach them.” The sound of a bell rings out to announce lunch. The group gathers in the ranch’s main building for a modest meal of white rice and a tough steak. They recite a blessing over the food and eat in silence.
Word of the group’s arrival reached Haim as well. “I wanted to thank them, in my name and on behalf of the Jewish people. I offered them a day of horseback riding in the area. They came here and fell in love. We fell in love with them, too.” The group stayed at the ranch for three months, building everything by hand. “They were like a miracle for us,” Haim says. “We didn’t have a dime.” This latest visit, about a month long, focused entirely on constructing the new center.
Zach first visited Israel in 2014. This is his fourth trip. “It was very important for me to come help, to build and strengthen Israel,” he said. “Israel is the light of the world, maybe even the foundation of the world. I don’t know how to explain it, but when you’re here, you feel it.”
What does it mean to be a Christian Zionist?
“Some people call us that. Maybe it’s accurate,” he said. “We don’t have definitions.”
How do you define yourself?
“We don’t spend much time defining it. We’re somewhat different. We just go by the Bible. We’re not part of any church. It’s not really a movement. Nobody knows us. It started with our family, and people joined.”
I watch a video of a Shabbat meal at the family home in Montana: Kiddush over wine, Sabbath songs and a reading of the weekly Torah portion. They look a bit like the Amish. “We are not evangelicals”, he insisted. “We’re not trying to convert anyone. And I don’t even understand why I would need to convert anyone.” “We’re not evangelicals,” Bethany says as well, “but we’re fairly close to that.”
Zach, have you noticed a change in Israel compared to your previous visits?
“Since the war, I think people have come to see more clearly how deep and destructive evil can be. In America, it’s created a serious division. Many think Israel shouldn’t exist. That’s what’s being taught in schools today. They don’t know what’s happening here.”
That’s what they’re teaching in schools?
“We didn’t attend public schools,” he says. “Our parents pulled us out because they were teaching us lies.”
Zach also refers to John Plucker as the group’s unofficial leader. “I go where John tells me,” he explains. The fact that Plucker is 12 years younger does not seem to matter. The Strain and Plucker families have known each other for years and are closely connected. Two of the Plucker daughters are married to two of the Strain sons.
“‘Unofficial leader’ is a good definition,” agrees John Plucker, 27.
Are you really a cowboy?
“Yes. That’s how I grew up, on a traditional ranch with horses and cattle and everything. Today I’m an independent contractor and run a construction company. There’s not much money in ranching. It’s more of a lifestyle. I want to work a few more years and buy some land.”
Plucker does not define himself as a Christian Zionist. “I’m just a regular Christian,” he says. “But I see Israel the same way they do, and we believe the same things, so maybe I am a Christian Zionist? I don’t know. Honestly, I don’t really care.”
4 View gallery
The cowboys in Montana fields
(Photo: Courtesy)
So why did you come?
“The Strains have been coming for years, and they convinced me. We all love Israel very much. The first time I was here was after COVID, and it was incredible. HaYovel brought us. They believe God gave this place to the Jewish people. Here I learned a lot about redemption. You can see it happening in real time. It’s powerful. You learn much more here than just by reading the Bible.”
The last time he came was in November 2023. “They brought us to work in Shiloh, harvesting olives. The moment I came to the ranch, I fell in love, even though there was nothing here yet. My background is ranching and horses, so this suited me much more than picking olives, which is a pretty strange job, honestly. We didn’t hesitate to return, even though our baby had just been born.
“I see what they’re doing here with the young men and women who come for therapy. They give them purpose. They turn something negative into positive. It really brings redemption into people’s lives. I’m glad to be part of it. I already want to come back again. Staying in one place for a long time, building relationships, that’s a blessing.”
When I ask about politics, the group responds with puzzled looks, as if they had never even heard of Trump.“We’re simple ranchers,” Plucker said. “These things don’t interest us. We’re aligned with conservative views, but I don’t really understand politics. I’m here for the Jewish people. Politics may be important here, but not for us.”
By midday, the horses are released ahead of the afternoon’s therapy sessions. I meet Aviv, Sinai, Negev, Pele, Pazit, Milky and Moshe, a large black horse. I do not ride, but standing beside them, something shifts. A horse is a wonder. Sinai, a horse, or perhaps a mare, I didn’t check, walks toward me and looks straight into my soul. We share a quiet moment.
What is it about horses?
“A horse is a spiritual animal,” Ruthy said from atop Negev. “Every encounter with a horse exposes the soul. The horse immediately senses your frequency. If you’re tense, it’s tense. If you’re calm, it’s calm.”
“What allowed horses to survive for 80 million years is extreme sensitivity,” Haim said. “They are alert to fear, to anxiety. They feel your heartbeat, your breathing. A horse is a perfect mirror for someone living with PTSD. When a person jumps at the sound of a motorcycle and shifts into survival mode, the horse shifts just as quickly. And when you calm down, the horse calms down with you. It forces you to lead, not with force, but with quiet confidence.”
Ruthy sees symbolism as well. “A horse is an open, unburdened space. The entire archetype of the horse is about strength and success, getting back on the horse, being on top of things. That’s also our therapeutic philosophy: to reconnect with that life force, to climb back into the saddle even after the hardest falls. It restores a sense of control to people who have lost all control over their lives.”
Montana
Evacuation orders issued as 5,000-acre wildfire burns near Roundup, Montana
ROUNDUP, Mont. —
The Rehder Creek Fire is burning 16 miles southeast of Roundup has grown to about 5,000 acres, prompting evacuation orders for residents in the Bruner Mountain Area/Subdivision.
The fire started Feb. 26, the cause is unknown and containment was at 0%.
Evacuation orders are in effect for all residents in the Bruner Mountain Area/Subdivision. The Musselshell County Sheriff’s Office is coordinating the evacuation orders, and 911 reverse calls have been sent out to advise people in the area.
A shelter is opening at the Roundup Community Center. Residents were told to contact Musselshell County DES for further information.
Firefighter and public safety remain the top priority. The public is asked to avoid the Fattig Creek and Rehder Road area so emergency personnel can safely and effectively perform their work.
Fire resources assigned to the incident include 40 total personnel, 11 engines, one Type 2 helicopter, three tenders and two dozers.
Montana
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