Bozeman Health will maintain and expand Big Sky services; projects BSMC will be self-sufficient beginning this year
By Jen Clancey STAFF WRITER
In June, the Bozeman Health Big Sky Medical Center appeared on a 338-piece list of at-risk rural hospitals that could be impacted by cuts to Medicaid and Medicare in the “One Big Beautiful Bill.” In a statement to EBS, Bozeman Health, the nonprofit health system that operates the medical center in Big Sky Town Center, assured a commitment to serve patients regardless of insurance status, and to providing quality care.
The hospital is not the only facility in the state—let alone the country—potentially facing service and financial concerns. Seven other hospitals in Montana were listed as at-risk before the U.S. House voted in favor of Medicaid cuts via the OBBB on July 3. The list identified hospitals that either treated a high percentage of Medicaid patients, or operated with negative margins for three consecutive years—the report included Big Sky Medical Center in the latter.
“The operations at Big Sky Medical Center, since its opening in December 2015, have often required financial subsidy by the Bozeman Health system,” Bozeman Health representative Erin Schaible wrote in a statement to EBS regarding the report by the University of North Carolina’s Shep Center. “Over the years, the need for financial support from the system has slowly diminished as the volume of services provided has increased. We anticipate that Big Sky Medical Center will be financially self-sufficient beginning in 2025.
“Regardless, Bozeman Health remains fully committed to maintaining and expanding the services offered at Big Sky Medical Center to meet the needs of the growing Big Sky community.”
Bozeman Health CEO Dr. Kathryn Bertany stated that Montana may not feel the restrictions in the short term.
“While the proposed national Medicaid cuts are concerning, Montana is fortunately positioned better than many other states,” Bertany stated in an email to EBS. In a July 1 press release from the Montana Hospital Association, President and CEO Ed Buttrey noted that Montana’s lower Medicaid tax rates make the impact of the change less than other rural states.
“Our state leaders have designed a Medicaid program that operates within our means and well below various thresholds previously set by the federal government to contain spending,” Buttrey stated in the release.
Medical leaders remain concerned, despite the relatively small impact to Montana’s health care system.
“We are relieved that new restrictions on how states finance their Medicaid programs will not impact Montana Medicaid today, but we remain concerned that the measures passed by the Senate today could have serious consequences for our state long-term,” Buttrey stated.
The bill, signed into law by President Donald Trump on July 4, will require Medicaid expansion enrollees to pay a copay of up to $35 if they exceed 100% of the federal poverty level, with the change going into effect by October 2028. The 2027 Montana Legislature will need to address the copay agreement, which Montana currently prohibits.
Outside of Medicaid coverage, Affordable Care Act enhanced tax credits are expected to end at the close of 2025 due to the bill. According to KFF, a health policy and news organization, approximately 77,000 Montanans are enrolled in the ACA healthcare marketplace. When a person doesn’t have employer-sponsored health insurance and doesn’t qualify for Medicaid, they are able to purchase insurance through the ACA. But advanced premium tax credits for ACA are slated to be terminated by the end of 2025 in the OBBB, and would increase out-of-pocket costs of healthcare.
“The elimination of these tax credits will increase the cost of marketplace insurance for those who rely on it for their health care coverage; many may not be able to afford the difference and be forced to lose their insurance,” Bertany stated.
MHA’s Buttrey noted that Medicaid cuts will impact the state’s Medicaid program, its patients and its beneficiaries in Montana’s “extremely rural health care system.” Bertany noted that Bozeman Health and the Big Sky Medical Center will continue to provide quality healthcare in the region.
“At Bozeman Health, including Big Sky Medical Center, we remain fully committed to serving the health care needs of both residents and visitors in the communities we serve regardless of their insurance benefits,” Bertany stated.
