Legislative analysts flag lower Medicaid caseload, FMAP shifts in senior and long-term care budget

Legislative Fiscal Division analysts told the Montana Legislature’s Section B appropriations subcommittee on the senior and long-term care budget that the executive’s biennial request is smaller than the 2025 base because projected Medicaid caseload and federal match changes reduce benefit-and-claims spending.

Analyst Dr. Brian Pollet, presenting the LFD review, said the division’s request shows an overall reduction of about 5.8 percent from the base driven mainly by a 6.2 percent drop in benefits and claims; general fund demand rises because of a projected decline in the federal medical assistance percentage (FMAP). “This division is mostly traditional Medicaid, so when FMAP changes it affects this division in a very noticeable way,” Pollet said.

Why it matters: senior and long-term care is a large Medicaid budget slice in Montana; changes to FMAP, provider rates adopted last session and shifts in where care is delivered (nursing homes versus home- and community-based services) can move tens of millions of dollars in state general fund need.

Key numbers and drivers - Pollet reviewed actuals and appropriations: FY2024 actual expenditures…