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Montana’s newest Medicaid report shows a difficult trend: enrollment has fallen to its lowest level since the program expanded, and the amount of unpaid “charity care” hospitals are absorbing is climbing back toward pre-expansion levels.
For people trying to find free rehabs in Montana, the changes mean treatment access is getting harder for some, even as other coverage options, including Medicare, remain in place.
Charity Care Is Climbing as Enrollment Falls
The 2026 Medicaid in Montana report, produced by the Montana Healthcare Foundation, found enrollment dropped to 217,711 people in 2025, a 6.1% decline in a single year.
As coverage has shrunk, uncompensated care, the unpaid care hospitals are required to provide, has surged. Statewide uncompensated care rose from $179 million in 2017 to $370 million last year.
Critical-access hospitals, which serve as rural lifelines, saw their uncompensated care nearly double, from $11 million in 2017 to $21 million in 2024. Foundation director Dr. Aaron Wernham described the trend as concerning for the state’s low-margin rural healthcare systems.
Why Coverage Is Getting Harder to Keep
Montana lawmakers, with support from Gov. Greg Gianforte, ended the state’s “continuous eligibility” policy and switched to rolling redetermination, which checks Medicaid eligibility throughout the year instead of annually.
Wernham said the data shows most people losing insurance coverage aren’t actually ineligible. Roughly half lost benefits over incomplete paperwork or missed mail rather than a change in their qualifying status.
Long wait times and confusing applications have pushed some Montana healthcare systems to hire staff dedicated to helping patients navigate enrollment.
New federal work requirements begin in July, though the foundation’s data shows 94% of current enrollees are already exempt as workers, caregivers, students, or people with disabilities, so a relatively small share of adults are expected to be affected.
Medicare Options Remain Available for Seniors
While this report centers on Medicaid, it’s worth noting that Medicare, the program covering most Montanans 65 and older as well as younger residents with qualifying disabilities, is a separate system unaffected by these Medicaid eligibility changes.
Montanans on Medicare can still access substance use and mental health treatment, including inpatient rehab, outpatient counseling, and medication-assisted treatment, through their existing benefits.
If you or a loved one is on Medicare, coverage for addiction and mental health treatment remains intact regardless of the Medicaid trends described above.
Who Still Qualifies for Free or Low-Cost Treatment
More than one in five Montanans remain covered by Medicaid, including about 40% of the state’s children. And despite the enrollment drop, the people who do have coverage are using it more for behavioral health.
Addiction treatment cases rose from 1,115 in 2015 to 6,972 in 2024, a 525% increase, while mental health treatment cases grew from 18,028 to 43,718 over the same period.
How to Access These Resources
- Check your Medicaid status with the Montana Department of Public Health and Human Services, since many denials stem from paperwork issues rather than actual ineligibility.
- Ask hospitals about charity care or sliding-scale fees, since uncompensated care programs are required at many facilities.
- If you’re 65 or older, or qualify by disability, ask providers about Medicare-covered rehab and mental health benefits.
- Contact SAMHSA’s national helpline at 1-800-662-4357 for free, confidential treatment referrals.
Free and Low-Cost Rehabs in Montana
Rural counties with high Medicaid use, including Roosevelt, Glacier, and Big Horn counties, have seen some of the strongest gains in added behavioral health services even amid the statewide enrollment decline.
Whether you’re covered by Medicaid, Medicare, or neither, free and reduced-cost treatment options still exist throughout Montana.
Search Rehabs.org’s directory to find low-cost and free rehab options nationwide. Call
800-914-7089
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to access affordable care today.
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