Reports: Medicaid Cuts in ‘Big Beautiful Bill’ Will Leave Montana Residents Without Insurance
Cuts likely to impact rural healthcare, shrink state’s economy
By Darrell Ehrlick, Daily Montanan
No state stands to lose more in Medicaid cuts being discussed in the “Big Beautiful Bill” than Montana, according to several new reports. That translates to nearly 40,000 people losing health insurance, billions taken out of the state’s economy, and a new mountain of paperwork for state workers.
Current projections show that 31,000 to 38,000 Montanans could lose health coverage, with small and rural healthcare organizations taking a huge financial hit, while increasing paperwork and requirements for less federal funding.
The Montana Healthcare Foundation, which has tracked the results of Medicaid’s expansion in the Treasure State since its inception, as well as publishing yearly academic research on its effects on the state, reports that no state stands to lose more on a per-capita basis than Montana.
“On a percentage basis, Montana would lose more federal funding than any other state in the country, with an estimated 32% decrease in federal Medicaid funds over the next 10 years,” says a new report issued by the foundation titled “The One Big Beautiful Bill Act: Impacts on Montana Medicaid.”
Medicaid in Montana covers nearly 1-in-every-5 residents, and estimates say that as many as 38,000 people could lose healthcare coverage, with 4,000 of those being elderly, children or disabled Montanans.
The Daily Montanan sent questions to both of Montana’s U.S. senators, Steve Daines and Tim Sheehy, including whether they supported the bill, and if they had concerns about its economic impacts on the health of Montanans or the state’s healthcare system. Neither of the senators, both Republicans, responded to questions.
But Daines appeared on FOX News on Tuesday, claiming it was Democrats who wanted to doom Medicaid, and that it was the Republicans who were looking out for it.
“It’s an important safety net, but we’ve got to reform Medicaid if we’re going to save Medicaid. We’ve got to take able-bodied males who are laying on the couches at home and get them back to work and off of Medicaid,” Daines said.
However, data tracked by state leaders show that 93% of people enrolled in Medicaid in Montana either work at least part-time, are full-time students, disabled or elderly, with the remaining small percentage being people who have recently lost a job or are transitioning to one of the other categories. Meanwhile, the federal Bureau of Labor Statistics confirms those estimates another way: As of February 2025, it estimated fewer than 17,000 in Montana who were eligible for the workforce were not employed, consistent with the state’s historically low unemployment rate.
Montana, which places a tax on healthcare providers to help support Medicaid’s expansion, would also be prohibited from increasing or adding to those taxes in order to help support the program — even though the taxation program has been highlighted by conservative lawmakers as a way to help share costs, even among the businesses that benefit by the expanded coverage.
The Montana Healthcare Foundation estimated that the state would lose $5.7 billion during the course of the next 10 years from federal support, shifting the burden to Montana, leaving state officials to choose whether to increase funding or decrease coverage.
The Robert Wood Johnson Foundation estimated that nationally, 16 million people would likely lose some form of health care. It also said that uncompensated care — that is, care that hospitals have to provide without reimbursement due to a lack of insurance — will soar by $283 billion during the next nine years in America, if the bill is passed.
In Montana, the report said that Montana healthcare will lose billions in the next decade, in a variety of areas, while increasing the cost of uncompensated care, creating a sort of double-whammy hit:
A loss of $2.6 billion in spending ($1 billion loss to hospitals, $200 million less to physicians, $700 million to other healthcare services, $800 million to prescription drugs).
An increase of $1.2 billion in uncompensated care ($300 million to hospitals, $100 million to physicians, $500 million to other healthcare services, $200 to prescription drugs).
Rural Areas Impacted Most
Various reports analyzing the bill seem to center on at least one common conclusion: The cuts that would be required in the new Medicaid provisions would disproportionately hit rural providers in Montana. That spells trouble for two-thirds of Montana’s Medicaid-covered population who live in rural areas.
“Since Montana expanded Medicaid in 2016, 93% of Montana’s critical access hospitals reported adding or expanding specialty care services allowing them to provide care to rural Montanans previously only accessible in more urban areas,” the Montana Healthcare Foundation report said.
Logistical Challenges
Some of the reports analyze what the changes in the reconciliation bill would mandate, and one of the new wrinkles include more work requirements for participants, which would, in turn, require a significant increase in documentation by states.
One of the new proposed work requirements would mandate 80 hours of work or qualifying activities per month to be eligible for Medicaid. This would require the state to develop and implement new tracking systems to verify the work. Even for someone who has lost a job, they would still have to demonstrate they’re working 80 hours to enroll in the program, according to the Healthcare Foundation.
Workers could see more “churn” or cycles of qualifying or not qualifying that would lead to inconsistent coverage and potential bureaucratic hassles.
“It would also cause ‘churning’ in and out of coverage for eligible adults, particularly for Montana’s seasonal workers such as firefighters and agricultural workers,” the report said.
This eligibility process, which requires “redetermination,” shifted in Montana to a yearly verification, as well as checking work requirement in 2023. That resulted in the Montana Department of Public Health and Human Services to admit that thousands of Montana residents lost coverage because of technical issues, not related to eligibility, but to paperwork related to the process. New provisions within the “Big Beautiful Bill” would shift the redetermination period to every six months, speeding up the already cumbersome process.
“In (2023), nearly two-thirds (63%) of enrollees lost coverage due to procedural reasons, like incomplete paperwork, and not because they were determined ineligible,” the foundation report said.
Hurting The State’s Budget
According to the Pew Charitable Foundation’s analysis of how the Medicaid changes in the federal bill affect local states, researchers broke down impacts on state budgets, and the results show a destabilizing effect on the Treasure State.
For example, the recent Medicaid expansion with federal support has helped stabilize the state budget. Montana’s trend line has shown a decreasing amount of state support and increasingly better healthcare outcomes for its residents.
For example, since 2023, the state’s overall contribution to the program has shrunk from 9.9% to 9.2% of the budget. Most of the states that touch Montana, with the exception of North Dakota, have seen a similar trend line where they spent less than the previous 15-year average on Medicaid.
According to Pew, most states’ spending pattern shows a general decrease in state spending, which has allowed Montana and others to spend money elsewhere.
Montana also fares better than most states because of its Medicaid agreement with the federal government. The average state contributes nearly one-third of the cost, while the federal government contributes the rest. But in Montana, the federal government covers nearly 80% of the cost, meaning that any cut to Medicaid overall will have an outsized and likely negative impact on Montana.