Montana hospital widens financial aid to households up to 400% of the poverty level

Livingston HealthCare, a 25-bed critical access hospital in Livingston, Montana, has rewritten the policy that decides which patients get free or discounted care. The new financial assistance policy² took effect August 19, 2026, and the hospital announced it in a September 28 news release¹.

The policy sets three tiers. Households at or below 200% of the federal poverty level receive a 100% discount, those from 201% to 300% receive 75%, and those from 301% to 400% receive 50%. The hospital's 2026 sliding fee schedule³ puts that in dollars: a family of four pays nothing on eligible bills with household income up to $66,000 and pays half with income up to $132,000. Those amounts are two and four times the 2026 federal poverty guideline⁷ of $33,000 for a household of four.

What changed

The earlier version of the policy, revised November 25, 2025⁵ and still posted on the hospital's website, tied partial assistance to incomes between 100% and 200% of the poverty level. It also required patients to be Montana residents or established patients, a rule the hospital said it has removed. A 2024 community benefit report⁶ from the hospital had described assistance up to 400% of the poverty level, but the hospital's posted policies from 2019 and 2025 used the narrower range.

The new policy also lists cases in which patients qualify without filing an application, including people who are homeless, who qualify for Medicaid (out-of-state Medicaid included), who are enrolled in a public assistance program for low-income people, or who are incarcerated. The 2025 version named only Medicaid eligibility as a basis for that kind of presumptive approval. KFF Health News reported⁹ on October 1 that six states require hospitals to screen patients this way, and Montana is not among them.

For households above 400% of the poverty level, a catastrophic provision caps the balance for an episode of care at 30% of annual household income. The 2025 policy applied the same cap to households above 250% of the poverty level. "We want patients to seek care when they need it," Chad Soden, the hospital's director of finance, said in the release.

Limits and basic facts

The assistance covers emergency and medically necessary care billed by Livingston HealthCare. Elective and cosmetic procedures are excluded, and so are bills from outside providers such as pathologists and radiologists, according to the hospital's plain language summary⁴. Applicants must also show limited liquid assets, apply for programs such as Medicaid, and generally apply within 240 days of the first bill after discharge; the policy says applications are reviewed within 30 days.

Federal tax rules require tax-exempt hospitals to have a written financial assistance policy that states who qualifies, but the Internal Revenue Service guidance⁸ does not set income limits. Under those rules, a patient who qualifies cannot be charged more than the amounts generally billed to insured patients for emergency or medically necessary care. At least 11 states require hospitals to provide free care to low-income patients, KFF Health News reported, citing the Commonwealth Fund.

The hospital describes itself as independent and nonprofit, with a Level 4 community trauma facility, a multispecialty clinic, and rehabilitation and home-based services. In the Centers for Medicare & Medicaid Services Hospital General Information dataset¹⁰, it is listed as a critical access hospital with emergency services and an overall star rating of 3 out of 5.