Montana’s Medicaid Future Now on the Chopping Block

BUTTE, MT - An in-depth look at the potential $880 billion in cuts and their implications for the Treasure State.

As the U.S. House Energy and Commerce Committee prepares to vote on proposed changes to Medicaid funding on May 13, 2025, concerns are mounting in Montana and across the country about what these changes could mean for everyday Americans—especially those who depend on Medicaid for healthcare.

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According to recent estimates from the nonpartisan Congressional Budget Office (CBO), House Republicans are considering slashing Medicaid by as much as $880 billion over the next decade.

While the stated intent is to reduce the federal deficit, analysts and public health advocates warn that the real-world impact would be a sharp rise in uninsured Americans, a loss of essential services, and devastating consequences for states like Montana.

The Montana Breakdown: Who’s at Risk?

Currently, 76,619 Montanans are enrolled in Medicaid, a number that includes low-income families, seniors, individuals with disabilities, and children.

If the proposed cuts become law, these individuals would be the most at risk of losing coverage or critical care access.

According to the Kaiser Family Foundation, the estimated impacts for Montana are stark:

• 69% of children on Medicaid could lose coverage or access to care.

• 34% of services for seniors and people with disabilities may be eliminated.

• 26% of coverage for adults under Medicaid expansion could disappear entirely.

These figures are not just projections—they’re a direct translation of what a $880 billion reduction means when divided among the states.

Montana, a rural state already grappling with provider shortages and access challenges, would feel the strain more acutely than most.

Undermining Recent State Legislation

Ironically, this federal proposal would directly conflict with Montana’s own legislative actions.

Just this year, Montana’s Republican-controlled state legislature renewed Medicaid expansion, a program that has helped reduce the state’s uninsured rate by 30% since its implementation a decade ago.

If federal matching funds for the Medicaid expansion population were reduced—as outlined in one of the CBO’s scenarios—Montana could be forced to reconsider or reverse its expansion altogether.

Under such a scenario, the federal government would no longer cover 90% of the cost for the expansion population, shifting a large financial burden back to the state.

As the CBO states, this could prompt states to:

• Raise taxes or cut funding for other services to compensate

• Reduce benefits or provider payment rates

• Cut enrollment entirely

This would mark a significant rollback in healthcare access for low-income Montanans.

The Bigger Picture: National and Local Fallout

The CBO analyzed five different policy options under consideration by the House. Among them, two stand out as particularly relevant for Montana:

1. Reducing the federal matching rate for Medicaid expansion (Option 1): Would result in 5.5 million Americans losing coverage, including 2.4 million who would become entirely uninsured.

2. Capping federal Medicaid spending per enrollee (Options 3 and 4): Would shift more responsibility to states and likely lead to cuts in services, provider payments, or enrollment.

In each case, Montana would face the same impossible choice as other states: either come up with millions in additional funding or watch its most vulnerable citizens lose access to care.

Moreover, the CBO explicitly projects that states, on average, would only be able to replace about half of the lost federal funding with their own resources—leaving a gaping shortfall in coverage and services.

What’s Next?

The Energy and Commerce Committee is expected to deliberate on the proposal on May 13. If these cuts move forward, Montana will have little time to react before facing potential budget holes and healthcare crises.

Advocates and public health officials across the state are urging residents to contact their federal representatives and make their voices heard. With healthcare access hanging in the balance for tens of thousands of Montanans, tomorrow’s vote could set the stage for one of the most significant healthcare shifts in the state’s recent history.