What Montana’s candidates for governor have to say about renewing Medicaid expansion

Montana’s Medicaid expansion program, a public health insurance option for low-income adults, is scheduled to sunset in June 2025. The coverage is heavily funded by the federal government but is administered by the state health department. If Montana lawmakers and the governor don’t pass legislation next year to reauthorize the program, last renewed in 2019 on a single-vote margin, Montana’s health care landscape would change dramatically. Upwards of 85,000 eligible adults could stand to lose coverage, according to the state’s latest enrollment figures. 

The June primary ballots will have five Republican, Libertarian and Democratic candidates for governor. Those candidates, including incumbent Gov. Greg Gianforte, a Republican, and prominent Democratic challenger Ryan Busse, have wide-ranging views on how to run the state’s Medicaid program and whether they would support reauthorization. As part of our 2024 Election Guide project, Montana Free Press asked candidates for governor where they stand on expanded Medicaid renewal via a written questionnaire. Here’s how they responded. (These answers were lightly edited for grammar but are otherwise presented verbatim.)

Gianforte’s response doesn’t give a clear ‘yes’ or ‘no’ to our question about reauthorizing Medicaid expansion in 2025. Throughout the campaign, the governor and his running mate, Lt. Gov. Kristin Juras, have endorsed the importance of the safety-net health care program but cautioned against letting it get too big or becoming a resource  for people who are not truly in need.  

The Montana Legislature and other states have previously tried to attach work requirements to Medicaid for able-bodied adult enrollees, but those efforts have been rejected by federal health authorities under the Biden administration. 

Busse has a clear ‘yes’ to the question of reauthorizing Medicaid Expansion in 2025. While Medicaid expansion doesn’t specifically cover children, it did expand eligibility for families and can help parents access services for their own health care needs. Medicaid expansion is a widely used resource for tribal members in Montana who want health care options beyond what is offered by Indian Health Services, the federally-funded system that often sees long wait times and limited services.

Busse’s reference to Gianforte’s handling of the 2023 post-pandemic Medicaid eligibility reviews stems from a comment the governor’s office made to KTVH in early April. In that statement, Gianforte’s staff said the administration had appropriately conducted reviews to make sure Medicaid coverage isn’t extended for people who no longer meet the program’s eligibility requirements.

Smith doesn’t take a clear stance on whether he would support the reauthorization of Medicaid expansion as it currently exists. Medicaid programs that cover children and other groups of people don’t need explicit reauthorization action by the Legislature next year, meaning they’ll likely remain intact, even if the Legislature chooses to scuttle the expanded coverage for eligible adults. 

A 2024 report from the Montana Healthcare Foundation, a nonprofit that has historically supported Medicaid expansion, found that 77% of adults covered by Medicaid in Montana worked full-time or were attending school. An additional 19% said they were disabled, had an impairment to work or were a caretaker for someone else. Only 3% of adult Medicaid enrollees said they were not working and did not have an impairment that prevented them from doing so.

Leib seems to suggest he would allow a reauthorization of Medicaid expansion to become law (which can happen either with the governor’s signature or if the governor chooses not to sign or veto a bill that has been passed by the Legislature). 

To Leib’s point about the program requiring more government spending: The same Montana Healthcare Foundation report from 2024 found that the state’s total Medicaid budget was $2.4 billion, but that the federal government reimburses Montana for about 80% of that spending annually, across all programs and populations. 

Since Montana first authorized expanded Medicaid in 2015, the overall program has consistently made up about 13% of the state’s General Fund spending, costing between $280 million and $320 million annually.

Hunt gave a clear ‘yes’ about supporting the reauthorization of Medicaid Expansion in 2025. Like other candidates, he seems to suggest children are covered by Medicaid expansion, rather than other distinct programs like Healthy Montana Kids or traditional Medicaid. 

Regarding how Medicaid expansion increases preventative care and decreases reliance on hospital emergency departments, recent data supports Hunt’s claim. The Montana Healthcare Foundation report found that Medicaid enrollees decreased the use of emergency health care services the longer they were covered by the public program. Among other services, the report said that Montanans used their Medicaid enrollment to seek cholesterol screenings, cancer and diabetes screening, exams for sexually transmitted infections, and mental health and substance use disorder treatments.

Medicaid Expansion was one of six issue questions we put to candidates for governor as part of our 2024 Election Guide project. See the others by visiting the guide here.