A bill to lift the 2025 sunset on Montana’s Medicaid expansion program was signed into law Thursday by Republican Gov. Greg Gianforte — though without a press release or public fanfare.
In a written statement Friday morning, a spokesperson for the governor said he supports the “safety net” of Medicaid “for those who truly need it,” while endorsing work requirements and other, undefined guardrails on the low-income health coverage program.
Gianforte’s approval of House Bill 245, sponsored by Rep. Ed Buttrey, R-Great Falls, punctuates the journey of one of the most high-profile policy bills this session. The legislation sparked hours of testimony from program supporters and minimal appearances from opponents.
Medicaid expansion refers to the part of the broader state-federal program that covers health care costs for more than 75,000 low-income adults between 18 and 65, according to December figures from the state health department. Those numbers have fluctuated in recent years — federal Biden-era regulations penalized states for removing beneficiaries during the COVID-19 public health emergency, leading Montana’s Medicaid expansion rolls to swell to more than 125,000 people.
The vast majority of Medicaid expansion costs, 90%, are paid for by the federal government, with the state picking up 10% of the tab using a variety of special revenue taxes and state General Fund dollars. Montana’s share in 2024 was slightly less than $100 million.
HB 245 ends the recurring termination date that has accompanied the Medicaid expansion program since lawmakers first approved it in 2015. It continues work requirements that legislators added in 2019 that have not taken effect because of the federal government’s changing stance on that policy, a landscape that may shift again under the administration of President Donald Trump.
“The governor supports strong work requirements for able-bodied adults without dependents, excluding seniors and single parents, to receive benefits, and believes that state laws and policies should aim to reduce dependency on government and instead encourage self-sufficiency,” said press secretary Kaitlin Price. “The governor is looking forward to working with the Trump Administration to secure a waiver from the administration to do just that.”
Buttrey, a business owner and board member of Benefis Health System based in Great Falls, has historically carried the legislation to create and renew the program. Speaking to Montana Free Press on Friday, he called Medicaid expansion “a great program” and said that he was glad for the governor’s signature.
“We have 10 years’ worth of data that shows that the program we designed is working and working well. There’s no need to change it, it’s a savings to our budget, it is providing help for people all across the state, it’s helping save our rural health care facilities,” Buttrey said. “Why would you want to change that or come up with another plan?”
A March public poll from MTFP and Rutgers University’s Eagleton Center for Public Interest Polling found that more than three-quarters of respondents supported Medicaid expansion, with 59% saying they “strongly” supported the program and 18% saying they “somewhat” supported it.
HB 245 advanced with comfortable margins in both the House and Senate during the session’s first half, benefitting from the support of a bipartisan coalition of lawmakers. It was supported by the Montana Chamber of Commerce, tribal governments, hospitals, health care providers and enrollees in the program.
Legislative Democrats also emphasized their unified support for Medicaid expansion over multiple sessions.
“It’s our issue, 100%. Democrats have always voted on behalf of health care for people. And yes, the governor signed it, and that’s awesome,” said Rep. Mary Caferro, D-Helena, who sits on the House Appropriations Committee. “It’s a recognition of how important the process, the services are for people.”
Other proposals from Democrats and Republicans would have changed Medicaid expansion in various ways or phased the program out completely. Most of those bills failed to advance, despite intense support from fiscal conservatives in both chambers.
Many Republican lawmakers who voted against Buttrey’s bill argued that the Medicaid expansion program does not do enough to guide enrollees into higher-wage employment and, ultimately, onto other forms of health insurance. Others said that the overall annual price tag of roughly $1 billion was too high and that Montana was unwise to rely on the federal government to keep the program solvent.
Senate President Matt Regier, R-Kalispell, was one of the chamber’s steady “no” votes on Buttrey’s bill. He also proposed legislation to increase the age of exemption from work requirements to 65, up from the current age of 55. That bill failed to advance off of the Senate floor.
During a February debate on the Senate floor, Regier suggested that Montana would be better off using the resources that go to Medicaid expansion in other ways.
“As Montana and Montana state government, we need to have a conversation of, what is the role of state government? What programs are beneficial mostly for the people of Montana?” Regier said.
State health department and legislative staff budget projections from February estimate that the state will spend between $89 million and $95 million on the expansion program in each of the next two fiscal years. The total program estimates range from roughly $960 million to just over $1 billion.
Congressional Republicans have considered cuts to Medicaid to offset continued tax cuts passed by the Trump administration in 2017, during the president’s first term.
Buttrey said he has spoken to Montana’s congressional delegation about those budget debates and has encouraged them not to destabilize a program that is working to keep health care accessible for enrollees.
“It could happen, but I just don’t see folks from Congress going home to their states and telling them that either hundreds of thousands or millions of people are going to lose coverage, or their taxpayers are going to pick up a much larger share of the cost,” Buttrey said on Friday. “I don’t see those changes.”
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