Medicaid expansion has a substantial effect on Montana’s economy. Each year, expansion brings over $600 million into Montana that would not otherwise be here. This money ripples through Montana’s economy, generating between 5,900 and 7,500, jobs and between $350-$385 million in personal income each year between 2018 and 2020. These results are consistent with the observed change in economic activity in other expansion states that experienced changes in Medicaid coverage and uninsurance similar to Montana. In addition to generating economic activity, Medicaid expansion appears to improve a variety of other outcomes—reducing crime, improving health, lowering debt, and creating a more robust health care sector. While the state pays a nominal amount for these benefits, the costs to the state budget are more than offset by the savings created by Medicaid expansion and by the revenues associated with increased economic activity.