Montana
Montana lawmakers hear conflicting arguments on renewing expanded Medicaid program • Daily Montanan
Lawmakers on the health and human services budget committee on Wednesday heard opposing presentations about Medicaid expansion in Montana and its purported benefits and drawbacks as the legislature sets up what will likely be one of its biggest decisions next year – whether it should continue the expanded Medicaid program or let it expire next June.
Under Medicaid expansion, which was created under the Affordable Care Act, able-bodied adults earning up to 138% of the Federal Poverty Level – around $20,782 annually this year for a single person – can get health insurance coverage paid for primarily by the federal government, but partially the state. As of June in Montana, there were around 81,000 people covered under expanded Medicaid out of a total of 228,000 covered by the overall program. Medicaid covers about one-fifth of Montana’s population.
That’s down from a peak of around 302,000 Montanans who were covered in June last year as the state started its unwinding process to boot people off the program who had automatically been re-enrolled during the COVID-19 federal emergency but were no longer eligible after the emergency ended.
Montana first expanded Medicaid here in 2015 and renewed the expansion in 2019. But the expanded portion of the program will expire in June if lawmakers choose not to renew it again during the 2025 legislative session that starts in January and will run for as long as 90 days.
Only 10 states have not expanded Medicaid coverage in the decade they have had the option.
The topic of expansion is sure to bring dozens of lobbyists, health care workers and officials, and people covered by expanded Medicaid to the Capitol to offer their viewpoints on what is currently a $2.4 billion program in Montana overall, with about $100 million annually initially coming out of the state’s General Fund for the expanded coverage. Nearly 80% of the Montana Medicaid budget is paid for with federal funds, and states receive a 90% match for funds for the expanded population.
Wednesday’s presentations offered starkly different viewpoints on the expanded portion. The first came from the data and analytics director of the Foundation for Government Accountability, a right-leaning think tank whose goals include stopping Medicaid expansion, and from the president of Paragon Health Institute, who was a special assistant for economic policy to former President Donald Trump.
The second came from two officials with policy firm Manatt Health, who outlined for lawmakers a report it compiled for the Montana Healthcare Foundation, a private foundation that works on health policy, that showed the benefits of Medicaid expansion in Montana for the past nine years.
Presenters say Medicaid keeping people from working, costing hospitals
The presentations from the former group by Hayden Dublois, the data and analytics director for the Foundation for Government Accountability, and Brian Blase, the president of Paragon, focused primarily on their contention that Medicaid expansion has ballooned the coverage pool beyond what was initially expected, benefited the health care industry over patients, put resources toward able-bodied adults instead of children and people with disabilities, and allowed people who are covered not to work.
Dublois said a public records request he submitted to the Montana Department of Public Health and Human Services for information on how many Medicaid recipients in Montana were working between 2019 and 2022. He claimed the data he received showed 54% of recipients in 2019 showed no earned income and that the number had jumped to 72% in 2022. The Manatt presentation would later on claim 66% of recipients were working and another 11% in school.
He said Montana’s slight dip from 23rd healthiest state in the nation in 2015 to 24th healthiest, according to United Health Foundation data, meant that claims that Medicaid helped bolster public health were not true.
And he lamented that Montana hospital profits had decreased after Medicaid expansion due in part to reimbursement rates under expansion and to costs rising during a six-year period despite the state and federal government spending double what it had originally planned to for expansion because more people were eligible than expected.
“Montana’s relative ranking in health outcomes has dropped and the preponderance of the research has shown that in rural areas in particular, outcomes are either nonexistent in terms of improvement or actually result in worsened outcomes than was expected,” Dublois said. “Hospitals are still under financial strain because cost increases outweighed the revenue gains post-expansion. Spending is up and enrollment is up.”
Blase gave a similar presentation, lamenting what he said was an overly costly expansion program that cost other Medicaid recipients quality care and saying there was “no health benefit” associated with Medicaid expansion. He, like Dublois, suggested that the expansion population would be better off getting private insurance or insurance from the ACA marketplace.
“If Montana were to not have Medicaid expansion, the people above 100% of the poverty line, they would move to the exchanges; they would qualify for a very large premium tax credit,” he said. “…So you would have a loss in Medicaid but you would have a significant increase in both private coverage as well as in employer coverage because some of those individuals who are on Medicaid would otherwise be on an employer plan.”
In response to a question from Sen. Carl Glimm, R-Kila, about what population he estimated would fall into that category, Hayden said while he hadn’t looked deeply at data, he believed roughly 20,000 to 30,000 might be eligible for what he called “enhanced private exchange coverage.”
Other group says expanded Medicaid benefitting Montana
The presentation from Manatt Health senior managing director Patti Boozang and senior adviser Zoe Barnard essentially took the opposite stance and highlighted what the two said were vast benefits to Medicaid expansion in Montana and other states during the past decade.
“We’ve had expansion in place for quite a long time now, and there has been a lot of research, a lot of academic studies looking at the impact of Medicaid expansion on coverage, on access, on outcomes,” Boozang told the committee. “And I think the punchline here is that the overwhelming evidence is what Medicaid expansion has had positive effects on all of those measures of success or what we care about in our healthcare system and in our coverage programs.”
She pointed out that spending per Medicaid enrollee in all expansion states is higher for all Medicaid-eligible groups than in non-expansion states, that states have increasingly expanded Medicaid during the past seven years, including seven states by ballot initiative, and that most studies show expansion has positive overall effects for providers, users and states while lowering uncompensated care costs for hospitals.
Barnard told the budget committee that the expanded Medicaid program in Montana has reduced the uninsured rate by 30%, from 16.4% in 2015 to 11.4% in 2022, by filling the gap for people who would not typically qualify for Medicaid or employer-sponsored insurance.
Rep. Mary Caferro, D-Helena, noted that someone working on Montana’s minimum wage would make around $1,000 more annually than the 138% of the Federal Poverty Level and would not qualify even under expansion.
“I know you didn’t ask that, but I thought it might be useful,” she told the committee chair.
Barnard said Medicaid costs in 2023 were $2.4 billion, of which about 79% was funded by the federal government, 13% by the state General Fund, and 8% by special revenue funds. She said Medicaid expansion costs about $100 million a year, but about 25% is paid by hospitals.
But the state has since 2015 spent an average of 13% of the General Fund on Medicaid each year, Barnard said, meaning overall spending has only fluctuated by about $40,000 between 2015 and 2022.
She said expansion has reduced the cost of uncompensated care for Montana hospitals by about $150 million during the course of seven years. And she said Medicaid expansion has increased access to preventative care and behavioral health services.
Discussing the work requirement portion that has been part of the Medicaid expansion discussion in Montana for years, including a Senate bill that was shot down during the 2023 session, Barnard said a University of Montana economist’s analysis showed Medicaid did not decrease the labor force participation and that around 80% of adults receiving Medicaid are working or in school.
U.S. Bureau of Labor and Statistics data show Montana’s labor force participation rate was about 63.5% in 2015 and is currently around 62.9%. A poll released in early May found nearly three-in-four Montanans supported keeping expanded Medicaid.
“Montanans need to understand that expansion is not a government program keeping people form working,” Barnard said.
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.
Carrie Gilbertson has been executive director of Cancer Support Community Montana for just under two months, stepping into the role in April with more than 15 years of nonprofit experience and a lifetime of Montana roots.
The organization provides psychosocial and mental health support to anyone affected by cancer — not just those with a diagnosis, but also family members and others walking alongside them.
WATCH: Meet the new leader of Cancer Support Community Montana 🎗️
Cancer Support Community Montana names new executive director
“This mission of providing psycho-social supports and mental health supports for anyone impacted by cancer, not just that person who has the diagnosis, but also family members, anyone who is walking alongside someone as they experience that often scary diagnosis, that’s just something that’s important to me,” Gilbertson said.
Gilbertson’s role extends beyond the Bozeman office. Cancer Support Community Montana’s Missoula location is already up and running, and a Helena location is expected to be operating soon. Each presents its own set of challenges.
“Each hospital is different. They might have different resources. Their social workers might be connecting to things in a different way. So understanding what those hospitals need, what different participants need in each community, is going to be different just because the communities are different, resources are different,” Gilbertson said.
The Bozeman office has been operating for more than 20 years, providing a foundation that supports the organization’s broader statewide efforts.
“I think this is a crew that looks at what does this community need what do our participants need what are some of the changing landscapes in cancer care what things are the gaps that we see that we can maybe just jump right in and you know let’s see if we can provide that for people so that’s something I really love about this crew that I work with and just this mission that there is some flexibility in being able to adjust and adapt as we learn more,” Gilbertson said.
Those adaptations show up in unexpected ways. The organization converts its parking lot into a pickleball court every Friday morning.
“I didn’t know there was a pickleball court. I pulled in actually with my daughter pulled in and she was is that pickleball court and I was like oh, it kind of looks like it is so yeah that’s fun, every Friday morning we clear out the parking lot and put up the net and I haven’t played yet I’ve been watching just to kind of see how that game works but they take it pretty seriously,” Gilbertson said.
This story was reported on-air by a journalist and has been converted to this platform with the assistance of AI. Our editorial team verifies all reporting on all platforms for fairness and accuracy.
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