Every day across Montana, nursing homes care for some of our state’s most vulnerable citizens—seniors recovering from illness, veterans, individuals living with disabilities, and older adults who can no longer safely live on their own. Families trust these providers to deliver compassionate, quality care when they need it most.
That is why the recent decision by the Montana Department of Public Health and Human Services (DPHHS) to withhold most Medicaid provider rate increases approved by the 2025 Legislature is so concerning.
The Legislature approved these increases because lawmakers recognized a reality that healthcare providers confront every day: Medicaid reimbursement often falls well short of the actual cost of providing care. The approved 3% increase was not a windfall. It was not a bonus. It was a modest adjustment intended to help providers keep pace with inflation and continue serving Montana’s most vulnerable residents.
Now, those increases will not occur for most Medicaid providers on July 1.
While this decision affects many healthcare sectors including nursing homes, hospitals, assisted living communities, behavioral health providers, and others, the consequences will ultimately be felt by the people who depend on these services.
Montana’s nursing homes have spent years navigating extraordinary challenges. We have faced historic inflation, workforce shortages, rising healthcare costs, and increasing complexity in caring for residents with greater medical needs than ever before. Yet providers have continued to show up.
They have recruited and trained caregivers, invested in quality improvements, and worked collaboratively with state leaders to strengthen Montana’s long-term care system. While facilities across the country have struggled or closed, Montana providers have fought to preserve access to care in the communities that depend on them.
The financial challenges are real.
At Immanuel Living’s skilled nursing community in Kalispell, our average cost of providing care is approximately $481 per resident per day. Medicaid reimbursement averages just $292 per day. That means we lose roughly $189 every day for every Medicaid resident we serve.
We are not alone. Nursing homes across Montana absorb similar losses every day because caring for vulnerable seniors is not optional. Providers make up the difference through fundraising, private-pay revenue, operational efficiencies, and an unwavering commitment to the people entrusted to their care.
The problem is that healthcare providers did not create the state’s budget shortfall.
Providers do not determine Medicaid enrollment projections. We do not establish state budgets. We do not decide legislative appropriations. Yet many of the organizations responsible for caring for Montana’s most vulnerable citizens are now being asked to absorb the financial consequences.
The timing could not be worse.
Healthcare providers continue to compete for employees in one of the most challenging labor markets in recent memory. Wages have increased substantially and rightly so. Montana caregivers deserve competitive compensation for the demanding and meaningful work they perform every day. At the same time, providers face increasing costs for food, utilities, insurance, pharmaceuticals, supplies, and regulatory compliance.
Unlike most businesses, healthcare providers cannot simply raise prices to offset those costs. Medicaid reimbursement rates are established by the state. When reimbursement fails to keep pace with expenses, providers have fewer resources to invest in staff, services, and facility improvements.
The long-term consequences should concern every Montanan.
When nursing homes and other Medicaid providers struggle financially, access to care is threatened. Rural communities are especially vulnerable. If providers are forced to reduce services, limit admissions, or close programs, families may find themselves traveling hours from home to find care for a loved one.
This is not merely a provider issue. It is a community issue.
Montana’s population is aging rapidly. Demand for long-term care services, behavioral health services, and healthcare supports will continue to grow in the years ahead. We should be strengthening the network of providers that serve our parents, grandparents, veterans, neighbors, and individuals with disabilities not weakening it.
I recognize that balancing a state budget requires difficult decisions. I do not underestimate the challenges facing DPHHS or the Governor’s Office. However, balancing the budget on the backs of nursing homes and other Medicaid providers ultimately shifts costs elsewhere onto seniors, families, hospitals, local communities, and the very people these programs are designed to protect.
Montana’s healthcare providers are not asking for special treatment. We are simply asking the state to honor the commitment that was already made.
There is still time to find another solution.
For the sake of Montana’s seniors and vulnerable citizens, I urge state leaders to revisit this decision and preserve the provider rate increases approved by the Legislature. The future of healthcare access in Montana depends on it.
Jason R. Cronk is president and CEO of Immanuel Living. Immanuel Living at Buffalo Hill is a faith-based senior living community in Kalispell, providing independent living, assisted living, memory support, skilled nursing, and home-based services.