A moral moment for Montana: Medicaid cuts considered in the U.S. Senate

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3 days ago

Rally attendees hold signs at a rally in support of reauthorizing Medicaid expansion at the Montana State Capitol on Jan. 15, 2025. (Micah Drew/Daily Montanan)
Last week, by a single vote, the U.S. House of Representatives passed the 'One Big, Beautiful Bill Act.'
This is sweeping reconciliation bill that promises to reshape the American social safety net. At the heart of this legislation are more than $700 billion in cuts to Medicaid, a program that serves as a lifeline for tens of thousands of Montanans with disabilities.
Medicaid pays for some of the most basic services many people with disabilities need to get by each day, like the basic personal care supports someone with a physical disability may need to get out of bed in the morning, the more intensive skill training and safety supervision someone with an intellectual disability may need to learn to live more independently, and it pays for medication to maintain a person's mental health and more intensive community supports when they have mental health emergency. For Montanans with disabilities, this bill is not just a policy shift – it's a direct threat to our lives.
The bill imposes new administrative hurdles, including requiring Medicaid recipients to reverify their eligibility twice a year. For people with disabilities – many of whom already navigate complex bureaucracies – this change increases the risk of losing coverage due to paperwork errors or missed deadlines. Here in Montana, we know this isn't a mere possibility, it was our reality. In 2023 and 2024, Montana required Medicaid recipients to submit paperwork to verify their continued eligibility. When Montanans tried to follow the rules to verify their eligibility, they found the state's phone lines were left unanswered and many people were kicked off for administrative reasons without ever looking at their clinical need.
Though the bill includes exemptions, these are often poorly implemented. In practice, people are misclassified, denied exemptions, or fall through the cracks due to inaccessible systems. People with legitimate disabilities are stripped of their health care and there is a big administrative burden on the individual and the state eligibility system to sort through wrongful denials and terminations. When Arkansas implemented work requirements in 2018 similar to the work requirements in the new federal reconciliation bill, more than 18,000 people lost coverage, many of them wrongfully, and there was no meaningful impact on employment.
At Disability Rights Montana, we have been here for 50 years serving the disability community and we hear from people every day who rely on Medicaid to live independently, to work, to go to school, and to participate in their communities. These are veterans with PTSD, children with autism, adults with spinal cord injuries, and seniors with dementia. Defunding disability services is a major step backwards in history to a time when people with disabilities were excluded from society and warehoused in poor institutional conditions. This bill sends a clear message to people with disabilities that their lives are not as valuable as tax cuts for the rich.
Even if you don't have a disability or don't use Medicaid, you will feel the cuts. It is well known in health care circles that even Montanans who don't rely on Medicaid for their insurance coverage will feel the effects of this bill, especially in rural communities. For example, this year the state legislature heard from hospital administrators and healthcare providers who explained the impact Medicaid expansion has had on our state. It has allowed rural hospitals to add or expand specialty services like orthopedic surgery and mental health care. Without this funding, these services may disappear and that will affect all patients, not just those who are covered by Medicaid. Hospitals and other health care providers serve the rich and poor alike. When the money for poor people goes away, so do the therapists, nurses, and doctors that money paid for. If you lose funding to cover portions of health care professionals' salaries, those positions go away completely because you can't hire 60% of a doctor in a rural hospital.
The bill is now before the Senate. Given the slim political margins there, Sens. Daines and Sheehy could cast deciding votes. Budgets are moral documents. Just a couple months ago, the state legislature decided the moral choice was to maintain a robust Medicaid program for Montana. Now Senators Daines and Sheehy must answer the same moral question. What will they do?