Medicaid Expansion and Business Community Impact

Medicaid expansion plays a crucial role in the business community, supporting job creation, economic activity, and the overall stability of healthcare systems. It offers vital health coverage to low-income individuals, bridging the gap for those ineligible for traditional Medicaid but unable to afford insurance. Without this coverage, it results in increased medical debt and reduced access to care, negatively impacting both individuals and businesses.

• Medicaid Expansion
• Business Community
• Healthcare
• Economic Impact
• Job Creation

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1. Medicaid Expansion & the Business Community

2. Good health policy is good business policy.

3. Whats at stake: Medicaid Expansion

4. Why should we care? 7,500 jobs statewide and across multiple industries $475 million in personal income per year $775 million in economic activity per year $27 million funding gap in state budget per biennium The stability of our state s healthcare system The health of our low-income workforce

5. Why should we care? Total Program Cost: $2.15 billion (biennium budget) State General Fund: $82 million (biennium budget) State Special Funds: $55 million (biennium budget) Hospital Tax: $60 million (biennium budget) 25:1 Return-on-Investment: Montana secures $25 in healthcare services for every General Fund dollar spent, generating a 2,521% ROI (does not include economy-wide impacts) Without: Less access, fewer services, lost jobs, less healthy workforce, higher health premiums

6. What is Medicaid? State-federal partnership to provide health coverage to low- income adults, children, pregnant women, elderly adults and people with disabilities

7. What is Medicaid Expansion? Provides healthcare coverage for adults, ages 19-64, with incomes below 138 percent of the federal poverty level Equates to a monthly income of about $1,600 ($19,300 annually) for a single adult or $2,750 ($33,000 annually) for a family of three Covers approx. 80,000 Montanans (on average) who fall in the coverage gap Incomes too high to qualify for traditional Medicaid, but too low to afford health insurance or qualify for the insurance exchange Without coverage, seek healthcare in most emergent and expensive situations contributing to medical debt

8. Impact on Business & Employers Important source of health coverage for employees, especially in small businesses Every county had at least 30% of their businesses employing MT Medicaid participants 57% of private MT businesses had at least one employee enrolled in MT Medicaid, including 38% of businesses with 5 or fewer employees 16% of the private sector workforce is enrolled in MT Medicaid If employers had privately insured all workers enrolled in MT Medicaid in 2017, the cost to businesses would have been $353.6 million - $941.2 million -Montana Medicaid and Montana Employers, 2019

9. Impact on Business & Employers Businesses need healthy, productive workers Health coverage linked to higher workforce productivity In 2021, expansion supported preventative services for 61,000 people; mental health services for 34,000 people; and substance use disorder treatment for 5,500 people Key strategy in addressing workforce shortage Protects existing workforce and can grow capacity of workers age 18+ Major source of economic activity across Montana Enhances business recruitment & relocation prospecting Healthier workforce Stronger local healthcare system: financially viable, access and services preserved

10. A Closer Look: Sample County Supporting healthy, productive workers for Sample County businesses Provides coverage to 1,646 adults (ages 19-64) in Sample County (as of 10/2023), approx. 15.2% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 1,061 people in Sample County; Mental health services for 269 people in Sample County; and Substance use disorder treatment for 35 people in Sample County Supports key industries in Sample County Top industries, by employment: 1) Public Administration, 2) Retail Trade, 3) Food Services, and 4) Construction Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers Important source of economic activity in Sample County XX jobs created/supported | $XXX,000 in labor income | $X,XXX,000 in total output Protects access to care, prevents cost shift to other patients Lost revenues for Hospital: $494, 000 | Clinics and Ambulance: $70,000 | Townsend Drug: $627,000

11. Myths of Medicaid Expansion

12. Myth: Medicaid expansion builds dependency on government assistance. Fact: The average program participant is enrolled for less than 24 months. (DPHHS, 2019) Reforms passed in 2019 add additional community engagement requirements for participants and payments for certain groups.

13. Myth: People covered by Medicaid expansion dont work. Fact: 73% of program participants are working full-time, part-time or attending school. (Montana Healthcare Foundation, 2023)

14. Myth: Montanans dont support Medicaid expansion. Fact: 84% of Montana voters believe it is important to continue Medicaid expansion in Montana. (Montana Chamber of Commerce B-Base Poll, 2023)

15. Myth: Medicaid expansion doesnt impact me. Fact: The program impacts all of us, as it: 1. Creates and supports 7,500 jobs statewide and across multiple industries; 2. Generates $475 million of personal income and $775 million of economic activity annually; 3. Helps ensure the health for approx. 10% of our state s workforce, particularly in the following sectors: Accommodations and food services: 89% of businesses have workers enrolled Retail: 67% of businesses Construction: 54% of businesses

16. Myth: Medicaid expansion doesnt impact me. (Continued) Fact: The program impacts all of us, as it: 4. Stabilizes healthcare provider prices by reducing the pressure on commercial (employer- based) plans to cover revenue shortfalls from the un- and underinsured; 5. Reduces pressure on Montana taxpayers by securing federal funds for $27 million in state programs previously paid for by the state; 6. Preserves access and strengthens Montana s healthcare system that we all rely on, by reimbursing providers (physicians, dentists, substance use disorder treatment, mental health providers, pharmacies, hospitals, etc.) for care provided to previously un- and underinsured individuals; and 7. Funds major investments addressing the behavioral health crisis in our state.

17. Our Ask Position of Support Advocacy Join us in active and visible advocacy for this policy leading up to and during the 2025 legislative session. Join us in supporting the lifting of the sunset of Medicaid expansion in the 2025 legislative session.

18. Questions? Thank You! Bob Olsen President and CEO Montana Hospital Association bob.olsen@mtha.org 406-442-1911

19. Additional Counties

20. A Closer Look: Beaverhead County Supporting healthy, productive workers for Beaverhead County businesses Provides coverage to 685 adults (ages 19-64) in Beaverhead County (as of 11/2023), approx. 7.0% of county pop. From Jan. 2023 Jan. 2024, expansion supported: Preventative services for 539 people in Beaverhead County; Mental health services for 228 people in Beaverhead County; and Substance use disorder treatment for 15 people in Beaverhead County Supports key industries in Beaverhead County Top industries, by employment: 1) Retail Trade, 2) Educational Services, 3) Accommodations and Food Services, and 4) Construction Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers Important source of economic activity in Beaverhead County 39 jobs created/supported | $2,105,000 in labor income | $5,839,000 in total output Protects access to care, prevents cost shift to other patients Lost revenues for Barrett Hospital & HealthCare: $4,403,945 | Blacktail Pharmacy: $393,182

21. A Closer Look: Big Horn County Supporting healthy, productive workers for Big Horn County businesses Provides coverage to 1,783 adults (ages 19-64) in Big Horn County (as of 9/2023), approx. 13.8% of county pop. From Nov. 2022 Nov. 2023, expansion supported: Preventative services for 1,407 people in Big Horn County; Mental health services for 379 people in Big Horn County; and Substance use disorder treatment for 153 people in Big Horn County Major source of economic activity in Big Horn County 45 jobs created/supported $2.4 million in labor income $6.9 million in total output Supports key industries in Big Horn County Top industries, by employment: 1) Public Administration, 2) Educational Services, 3) Retail Trade, and 4) Accommodation & Food Services Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

22. A Closer Look: Broadwater County Supporting healthy, productive workers for Broadwater County businesses Provides coverage to 355 adults (ages 19-64) in Broadwater County (as of 10/2023), approx. 5.9% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 250 people in Broadwater County; Mental health services for 104 people in Broadwater County; and Substance use disorder treatment for 12 people in Broadwater County Supports key industries in Broadwater County Top industries, by employment: 1) Accommodations and Food Services, 2) Manufacturing, 3) Retail Trade, and 4) Construction Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers Important source of economic activity in Broadwater County 8 jobs created/supported | $365,000 in labor income | $1,211,000 in total output Protects access to care, prevents cost shift to other patients

23. A Closer Look: Cascade County Supporting healthy, productive workers for Cascade County businesses Provides coverage to 8,253 adults (ages 19-64) in Cascade County (as of 8/2023), approx. 9.7% of county pop. From Oct. 2022 Oct. 2023, expansion supported: Preventative services for 5,683 people in Cascade County; Mental health services for 3,343 people in Cascade County; and Substance use disorder treatment for 683 people in Cascade County Major source of economic activity in Cascade County 696 jobs created/supported $44.7 million in labor income $107.5 million in total output Supports key industries in Cascade County Top industries, by employment: 1) Healthcare, 2) Retail Trade, 3) Accommodation & Food Services, and 4) Construction Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

24. A Closer Look: Chouteau County Supporting healthy, productive workers for Chouteau County businesses Provides coverage to 436 adults (ages 19-64) in Chouteau County (as of 8/2023), approx. 7.3% of county pop. From Oct. 2022 Oct. 2023, expansion supported: Preventative services for 286 people in Chouteau County; Mental health services for 105 people in Chouteau County; and Substance use disorder treatment for less than 5 people in Chouteau County Major source of economic activity in Chouteau County 7 jobs created/supported $334,000 in labor income $1,145,000 in total output Supports key industries in Chouteau County Top industries, by employment: 1) Healthcare, 2) Public Administration, 3) Retail Trade, 4) Accommodation & Food Services Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

25. A Closer Look: Custer County Supporting healthy, productive workers for Custer County businesses Provides coverage to 1,050 adults (ages 19-64) in Custer County (as of 7/2023), approx. 9% of county pop. From Sept. 2022 Sept. 2023, expansion supported: Preventative services for 671 people in Custer County; Mental health services for 403 people in Custer County; and Substance use disorder treatment for 101 people in Custer County Major source of economic activity in Custer County 65 jobs created/supported $3.7 million in labor income $9.2 million in total output Supports key industries in Custer County Top industries, by employment: 1) Retail Trade, 2) Accommodation & Food Services, 3) Healthcare Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

26. A Closer Look: Daniels County Supporting healthy, productive workers for Daniels County businesses Provides coverage to 94 adults (ages 19-64) in Daniels County (as of 10/2023), approx. 5.6% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 2/3 of people enrolled in Daniels County; and Mental health services for 1/3 of people enrolled in Daniels County Important source of economic activity in Daniels County 8 jobs created/supported $406,000 in labor income $1,245,000 in total output Supports key industries in Daniels County Top industries, by employment: 1) Public Administration, 2) Wholesale Trade (Agriculture), 3) Finance and Insurance Medicaid provides health coverage to 1 in 5 laborers and ag workers

27. A Closer Look: Flathead County Supporting healthy, productive workers for Flathead County businesses Provides coverage to 9,310 adults (ages 19-64) in Flathead County (as of 9/2023), approx. 8.3% of county pop. From Nov. 2022 Nov. 2023, expansion supported: Preventative services for 6,795 people in Flathead County; Mental health services for 3,443 people in Flathead County; and Substance use disorder treatment for 726 people in Flathead County Major source of economic activity in Flathead County 799 jobs created/supported $52.7 million in labor income $124.9 million in total output Supports key industries in Flathead County Top industries, by employment: 1) Healthcare, 2) Retail Trade, 3) Accommodation & Food Services, and 4) Construction Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

28. A Closer Look: Richland County Supporting healthy, productive workers for Richland County businesses Provides coverage to 597 adults (ages 19-64) in Richland County (as of 10/2023), approx. 5.3% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 432 people in Richland County; Mental health services for 244 people in Richland County; and Substance use disorder treatment for 48 people in Richland County Important source of economic activity in Richland County 33 jobs created/supported $2,067,000 in labor income $5,249,000 in total output Supports key industries in Richland County Top industries, by employment: 1) Retail Trade, 2) Accommodation & Food Services, 3) Transportation & Warehousing, 4) Construction, and 5) Manufacturing Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

29. A Closer Look: Roosevelt County Supporting healthy, productive workers for Roosevelt County businesses Provides coverage to 1,646 adults (ages 19-64) in Roosevelt County (as of 10/2023), approx. 15.2% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 1,061 people in Roosevelt County; Mental health services for 269 people in Roosevelt County; and Substance use disorder treatment for 35 people in Roosevelt County Important source of economic activity in Roosevelt County 64 jobs created/supported $3,775,000 in labor income $10,558,000 in total output Supports key industries in Roosevelt County Top industries, by employment: 1) Public Administration, 2) Retail Trade, 3) Food Services, and 4) Construction Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

30. A Closer Look: Sheridan County Supporting healthy, productive workers for Sheridan County businesses Provides coverage to 177 adults (ages 19-64) in Sheridan County (as of 10/2023), approx. 5.0% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 100 people in Sheridan County; Mental health services for 63 people in Sheridan County; and Substance use disorder treatment for 6 people in Sheridan County Important source of economic activity in Sheridan County 9 jobs created/supported $519,000 in labor income $1,492,000 in total output Supports key industries in Sheridan County Top industries, by employment: 1) Retail Trade, 2) Public Administration, 3) Food Services, and 4) Wholesale Trade Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

31. A Closer Look: Teton County Supporting healthy, productive workers for Teton County businesses Provides coverage to 625 adults (ages 19-64) in Teton County (as of 8/2023), approx. 9.8% of county pop. From Oct. 2022 Oct. 2023, expansion supported: Preventative services for 436 people in Teton County; Mental health services for 169 people in Teton County; and Substance use disorder treatment for 9 people in Teton County Major source of economic activity in Teton County 16 jobs created/supported $678,000 in labor income $2,051,000 in total output Supports key industries in Teton County Top industries, by employment: 1) Public Administration, 2) Wholesale Trade, 3) Retail Trade, and 4) Accommodation & Food Services Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

32. A Closer Look: Valley County Supporting healthy, productive workers for Valley County businesses Provides coverage to 529 adults (ages 19-64) in Valley County (as of 10/2023), approx. 7.0% of county pop. From Dec. 2022 Dec. 2023, expansion supported: Preventative services for 373 people in Valley County; Mental health services for 208 people in Valley County; and Substance use disorder treatment for 38 people in Valley County Important source of economic activity in Valley County 36 jobs created/supported $2,014,000 in labor income $4,960,000 in total output Supports key industries in Valley County Top industries, by employment: 1) Accommodations and Food Services, 2) Public Administration, 3) Retail Trade, 4) Healthcare, and 5) Professional and Business Services Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers

33. A Closer Look: Yellowstone County Supporting healthy, productive workers for Yellowstone County businesses Provides coverage to 16,687 adults (ages 19-64) in Yellowstone County (as of 7/2023), approx. 10% of county pop. From Sept. 2022 Sept. 2023, expansion supported: Preventative services for 10,828 people in Yellowstone County; Mental health services for 7,484 people in Yellowstone County; and Substance use disorder treatment for 2,172 people in Yellowstone County Major source of economic activity in Yellowstone County 1,583 jobs created/supported $113.6 million in labor income $262.5 million in total output Supports key industries in Yellowstone County Top industries, by employment: 1) Healthcare, 2) Retail Trade, 3) Accommodation & Food Services Medicaid covers more than 30% of people working as maids/housekeepers, child care workers, and food service workers; more than 20% of personal care aides, waiters and waitresses, cashiers, retail salespeople and laborers