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Medicaid expansion in Montana has helped 1 in 10 Montanans access health care, saved taxpayers money and generated jobs. Despite this well-documented success, the program’s future is not secure. First, it is set to expire in June unless the Legislature renews it. Second, its effectiveness could be undermined by proposals to take coverage away from people who cannot meet onerous work and reporting requirements.

Most Montanans know about the health and economic benefits of this program. Less reported are the ways that Medicaid expansion enhances public safety. National statistics show that with Medicaid expansion, crime rates fall. This is driven in part by increasing access to mental health care and treatment for substance use disorders. The University of Montana Bureau of Business and Economic Research looked at a body of research and found that on a national level, Medicaid expansion has “reduced crime, generating social benefits worth more than $10-13 billion annually.” Research from Michigan shows that rates of recidivism fall by 46 percent when individuals have healthcare and social services.

One reason for this: Medicaid expansion decreases the burden on local services charged with keeping people safe. For example, when an uninsured individual’s mental health or substance use disorder turns into a crisis, providing emergency services puts a huge burden on limited local resources, including police and fire departments and emergency rooms. The ability to act in a preventative manner when possible allows these vital services to prioritize public safety.

Medicaid expansion also helps those on probation and parole successfully find their way out of the system. Forty-five percent of the people we interviewed for our report, "Set Up to Fail: Montana’s Probation & Parole System," said they had a history of mental health issues and 61 percent reported issues with substance use. Many people noted that lack of access to treatment contributed to why they were involved in the criminal justice system in the first place and why they were having trouble meeting their probation or parole requirements. Medicaid expansion increases access to these services and makes it easier for people to find work and successfully exit the criminal justice system, ultimately saving the state vital resources.

Medicaid expansion substantially reduces the cost to the Montana Department of Corrections for providing certain types of care for incarcerated people. Montana is constitutionally required to provide medical care for those in its custody. The reduced costs for the MDOC extend to necessary treatment for mental health issues and substance use disorders. MDOC has saved over $8 million under Medicaid expansion. Furthermore, Medicaid expansion has increased vital services, including mental health care and treatment for substance use disorders, to Montanans in pre-release centers. Without this access to care, hundreds of people in pre-release centers would depend on the emergency room for all of their healthcare. That would shift costs to already financially strapped counties and cities, and would prevent many people from accessing that care. Decreasing access to care would likely funnel many who are in need of treatment for mental health or substance use disorders back into our prison system. We shouldn’t be warehousing people with health needs in prison. It’s counterproductive, and it’s expensive.

The success of Medicaid expansion — including the public safety benefits — would be undermined if legislative attempts to add new, burdensome requirements move forward. Montana should be helping people find better jobs and develop skills rather than kicking them off health care when they need it.

The legislature must renew Montana’s valuable Medicaid program as is. It’s good for our economy, our neighbors and public safety.

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Caitlin Borgmann is the executive director of ACLU of Montana. 

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