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 .
