Montana
Medicaid unwinding deals blow to Native care in Montana
Jazmin Orozco Rodriguez
(KFF) About a year into the process of redetermining Medicaid eligibility after the covid-19 public health emergency, more than 20 million people have been kicked off the joint federal-state program for low-income families.
A chorus of stories recount the ways the unwinding has upended people’s lives, but Native Americans are proving particularly vulnerable to losing coverage and face greater obstacles to reenrolling in Medicaid or finding other coverage.
“From my perspective, it did not work how it should,” said Kristin Melli, a pediatric nurse practitioner in rural Kalispell, Montana, who also provides telehealth services to tribal members on the Fort Peck Reservation.
The redetermination process has compounded long-existing problems people on the reservation face when seeking care, she said. She saw several patients who were still eligible for benefits disenrolled. And a rise in uninsured tribal members undercuts their health systems, threatening the already tenuous access to care in Native communities.
One teenager, Melli recalled, lost coverage while seeking lifesaving care. Routine lab work raised flags, and in follow-ups Melli discovered the girl had a condition that could have killed her if untreated. Melli did not disclose details, to protect the patient’s privacy.
Melli said she spent weeks working with tribal nurses to coordinate lab monitoring and consultations with specialists for her patient. It wasn’t until the teen went to a specialist that Melli received a call saying she had been dropped from Medicaid coverage.
The girl’s parents told Melli they had reapplied to Medicaid a month earlier but hadn’t heard back. Melli’s patient eventually got the medication she needed with help from a pharmacist. The unwinding presented an unnecessary and burdensome obstacle to care.
Pat Flowers, Montana Democratic Senate minority leader, said during a political event in early April that 13,000 tribal members had been disenrolled in the state.
Native American and Alaska Native adults are enrolled in Medicaid at higher rates than their white counterparts, yet some tribal leaders still didn’t know exactly how many of their members had been disenrolled as of a survey conducted in February and March. The Tribal Self-Governance Advisory Committee of the Indian Health Service conducted and published the survey. Respondents included tribal leaders from Alaska, Arizona, Idaho, Montana, and New Mexico, among other states.
Tribal leaders reported many challenges related to the redetermination, including a lack of timely information provided to tribal members, patients unaware of the process or their disenrollment, long processing times, lack of staffing at the tribal level, lack of communication from their states, concerns with obtaining accurate tribal data, and in cases in which states have shared data, difficulties interpreting it.
Research and policy experts initially feared that vulnerable populations, including rural Indigenous communities and families of color, would experience greater and unique obstacles to renewing their health coverage and would be disproportionately harmed.
“They have a lot at stake and a lot to lose in this process,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and a research professor at the McCourt School of Public Policy. “I fear that that prediction is coming true.”
Cammie DuPuis-Pablo, tribal health communications director for the Confederated Salish and Kootenai Tribes in Montana, said the tribes don’t have an exact number of their members disenrolled since the redetermination began, but know some who lost coverage as far back as July still haven’t been reenrolled.
The tribes hosted their first outreach event in late April as part of their effort to help members through the process. The health care resource division is meeting people at home, making calls, and planning more events.
The tribes receive a list of members’ Medicaid status each month, DuPuis-Pablo said, but a list of those no longer insured by Medicaid would be more helpful.
Because of those data deficits, it’s unclear how many tribal members have been disenrolled.
“We are at the mercy of state Medicaid agencies on what they’re willing to share,” said Yvonne Myers, consultant on the Affordable Care Act and Medicaid for Citizen Potawatomi Nation Health Services in Oklahoma.
In Alaska, tribal health leaders struck a data-sharing agreement with the state in July but didn’t begin receiving information about their members’ coverage for about a month — at which point more than 9,500 Alaskans had already been disenrolled for procedural reasons.
“We already lost those people,” said Gennifer Moreau-Johnson, senior policy adviser in the Department of Intergovernmental Affairs at the Alaska Native Tribal Health Consortium, a nonprofit organization. “That’s a real impact.”
Because federal regulations don’t require states to track or report race and ethnicity data for people they disenroll, fewer than 10 states collect such information. While the data from these states does not show a higher rate of loss of coverage by race, a KFF report states that the data is limited and that a more accurate picture would require more demographic reporting from more states.
Tribal health leaders are concerned that a high number of disenrollments among their members is financially undercutting their health systems and ability to provide care.
“Just because they’ve fallen off Medicaid doesn’t mean we stop serving them,” said Jim Roberts, senior executive liaison in the Department of Intergovernmental Affairs of the Alaska Native Tribal Health Consortium. “It means we’re more reliant on other sources of funding to provide that care that are already underresourced.”
Three in 10 Native American and Alaska Native people younger than 65 rely on Medicaid, compared with 15% of their white counterparts. The Indian Health Service is responsible for providing care to approximately 2.6 million of the 9.7 million Native Americans and Alaska Natives in the U.S., but services vary across regions, clinics, and health centers. The agency itself has been chronically underfunded and unable to meet the needs of the population. For fiscal year 2024, Congress approved $6.96 billion for IHS, far less than the $51.4 billion tribal leaders called for.
Because of that historical deficit, tribal health systems lean on Medicaid reimbursement and other third-party payers, like Medicare, the Department of Veterans Affairs, and private insurance, to help fill the gap. Medicaid accounted for two-thirds of third-party IHS revenues as of 2021.
Some tribal health systems receive more federal funding through Medicaid than from IHS, Roberts said.
Tribal health leaders fear diminishing Medicaid dollars will exacerbate the long-standing health disparities — such as lower life expectancy, higher rates of chronic disease, and inferior access to care — that plague Native Americans.
The unwinding has become “all-consuming,” said Monique Martin, vice president of intergovernmental affairs for the Alaska Native Tribal Health Consortium.
“The state’s really having that focus be right into the minutiae of administrative tasks, like: How do we send text messages to 7,000 people?” Martin said. “We would much rather be talking about: How do we address social determinants of health?”
Melli said she has stopped hearing of tribal members on the Fort Peck Reservation losing their Medicaid coverage, but she wonders if that means disenrolled people didn’t seek help.
“Those are the ones that we really worry about,” she said, “all of these silent cases. … We only know about the ones we actually see.”
EL PASO, Texas (KTSM) — Following widespread neighborhood concerns first reported by KTSM 9 News on Friday, residents of the Montana Vista area came face-to-face with developers of the proposed “Pecos West” transmission line project on Saturday morning, May 9 during a community meeting held at the Montana Vista Community Center.
The multi-million dollar project, spearheaded by power grid developer Grid United, aims to build a massive transmission line connecting the El Paso area to southeastern New Mexico.
While developers tout the project as a crucial link to prevent grid bottlenecks, families living in the path of the proposed line continue to voice mounting frustration and distrust over how the land acquisition is being handled.
On Friday, Grid United released a statement to KTSM insisting their one-on-one land negotiations were conducted out of respect for private property rights. But at Saturday’s community gathering, residents and advocates made it clear they aren’t buying it.
“People are afraid. I’m not afraid. I’m angry,” said Armando Rodriguez, president of the Union of Montana Vista Landowners, who previously said that developers had been quietly approaching his neighbors for months with varying buyout offers.
Only about a dozen residents and advocates attended the weekend meeting, but they loudly questioned why the company spent the past year approaching landowners individually rather than addressing the community as a whole.
During the exchange, project officials admitted they have already acquired about 50 percent of the properties in the impacted area. Grid United later clarified to KTSM that the exact number fluctuates frequently, just like the proposed route.
Community organizers argued that the company’s isolated approach leaves residents vulnerable and misinformed.
“When a company like this turns up and says, ‘We’re going to buy your property.’ We must ensure that community members understand that they have the right to say no, or that they have the right to negotiate a higher value,” said Veronica Carbajal, an organizer with the Sembrando Esperanza Coalition.
Carbajal highlighted that the lack of widespread notification and a standardized compensation formula is creating deep unease.
“They’ve already bought properties, but they have not established notification to every resident that will be impacted, nor have they set up a formula for compensation,” Carbajal said. “So what we can see online through the title transfers is that there is a very wide distinction between how much people are being paid. We don’t want the community to be divided. We also want people to understand that this is voluntary. They do not have to sell if they don’t want to.”
A major point of contention at Saturday’s meeting was the threat of eminent domain. Grid United explained that, as a private company, they do not possess eminent domain authority, insisting that if a landowner refuses to sell, the company will simply find an alternative route.
“At Pecos West we’re very landowner-first approach,” said Alexis Marquez, Pecos West community relations manager. “So if a landowner does not want (the transmission line) on the property, then we would find alternative routes.”
But Rodriguez remains highly skeptical that the developers would simply walk away from targeted plots.
“A corporation as big as you, a multi-million dollar corporation, I find it hard to believe that you would invest money into something this big and just walk away if the family said, ‘No, I don’t want to sell it,’” Rodriguez told officials during the meeting. “The question is: Are you really serious about what you’re saying here? Or is this just another dog and pony show?”
Project leaders conceded they need to adjust their efforts in engaging and informing the community, promising more meetings to come. However, residents emphasized that trust is currently broken and will only be rebuilt with concrete action.
El Paso County Commissioner Jackie Butler, who helped organize the meeting, said the County has no power to halt the proposed project, but she said she has been communicating with project officials and is trying to connect them with community advocacy organizations.
“I learned very quickly that the County does not have any authority or permitting process to stop these kinds of projects. And so that’s when I started connecting Pecos West to community members so that they could get directly involved,” Butler said. “My questions to Pecos West have been, Why do you have to come through our community? And even if you have to build through our region, you should go around it.”
Moving forward, the residents in attendance made it clear they do not intend to sell their property. They are demanding Grid United bring all impacted neighbors to the table as a collective before any more land is purchased.
If the project continues to move forward, construction is not expected to begin until the mid-2030s.
The Montana Lottery offers multiple draw games for those aiming to win big.
Here’s a look at May 8, 2026, results for each game:
Winning Mega Millions numbers from May 8 drawing
37-47-49-51-58, Mega Ball: 16
Check Mega Millions payouts and previous drawings here.
Winning Big Sky Bonus numbers from May 8 drawing
09-14-18-20, Bonus: 16
Check Big Sky Bonus payouts and previous drawings here.
Winning Millionaire for Life numbers from May 8 drawing
14-16-21-43-51, Bonus: 03
Check Millionaire for Life 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.
Mobile home residents in Bozeman, Montana, say they’re being forced to choose between paying rent and paying medical costs.Courtesy of Jered McCafferty
35-year-old Benjamin Moore has lived in Mountain Meadows Mobile Home Park, outside Bozeman, Montana, since he was 17. This month, for the first time, he’s withholding his rent.
On May 1, Moore received a rent bill for $947, up 11 percent from the month before, and the second hike in nine months—the product of the park’s sale to an undisclosed buyer.
Moore hung a sign on his trailer that says “RENT STRIKE.” He and his neighbors in Mountain Meadows and nearby King Arthur Park, organized with the citywide group Bozeman Tenants United, are collectively withholding over $50,000 a month from their landlord.
Historically, trailer parks have been a relatively affordable housing option—a third of trailer park residents in America live below the poverty line. But on average, their cost of living has risen 45 percent over the past decade. By unionizing, the Bozeman trailer park tenants believe they might be able to fight the most recent rent hike—especially given the state of their housing.
For years, tenants say, the maintenance hasn’t been attended to: tree limbs hang perilously over trailers, and water shutoffs are a regular occurrence. “I cannot recall a time in the past 20 years where we had three straight months of water and power working all day, every day,” Moore said.
Shauna Thompson, another resident, calls the water “atrocious…like a Milky Way, like you’re drinking skim milk. It’s very nasty and turned off all the time, without any notice.” And tenants allege that they’ve experienced retribution for maintenance requests, punitive eviction attempts, and unsafe conditions.
“It’s really hard on people here,” Moore said. Some residents are “already paying their entire Social Security check for rent. It’s a very poor neighborhood. We’ve got old folks. We’ve got young families. We’ve got working-class people who can’t afford anything else.”
For the past four decades, a group called Oakland Properties has owned both trailer parks. When they learned about the sale, tenants were scared that their parks would be bulldozed, or that their rent would be increased even further, forcing them to move.
The tenants attempted to buy the parks themselves, but were decisively outbid. The winning bidder demanded an NDA. The transaction should be finalized next month, park owner Gary Oakland said, but residents still don’t know who’s going to own the land they live on.
This month’s rent hike, Oakland acknowledged, was “part and parcel” of the sale. But for tenants, it’s a catastrophe. On top of the $947 lot rent—more than double the national average—many residents also pay off home loans on their trailers, as well as insurance and utilities costs.
Oakland calls claims of broken utilities “nonsense”: “If it was such a bad place to live, why would the homes be selling for such high dollars?” he said. The rent strike, Oakland points out, is “just a group of people not paying their rent.”
Some people are rationing their medication to make ends meet, Moore said. “There’s one person who canceled Life Alert. It’s either Life Alert or rent, and if you don’t pay rent, they evict you and throw you in the streets.”
Tenant organizers across the nation have found a foothold in recent years organizing against individual landlords, and Bozeman’s tenant union, situated in one of the fastest-growing communities in the state, is no exception. Tenant unions from Los Angeles to Kansas City to New York have organized to win rent freezes, maintenance, and security in their homes.
Mobile home parks—increasingly private-equity-owned and uniquely at-risk in the face of climate disasters—are organizing, too: a group of trailer park residents in Columbia, Missouri, unionized in February. In Montana, as Rebecca Burns recently wrote for In These Times, mobile homes were already once a site of tenant organizing: buoyed by the state’s miners unions, the first Bozeman-area mobile home tenants’ union won an agreement with their landlord in 1978.
Oakland says park residents “have been terrorized by the union,” and plans to evict the strikers. The strikers say they’ve retained a lawyer and will fight to stay in their homes.
“I wish none of this was happening,” Moore said. “Your utilities should work. Your place should be safe. You should be able to get in and out of it. These are the absolute basics, and they just haven’t kept them up. And if you call them on it, they threaten you.”
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