Financial leadership for Montana clinics serving a rural footprint across the country's fourth-largest state

5.9% top individual income tax (post-reform)

Montana's individual income tax was restructured for tax year 2024 and beyond, with the top rate dropping from 6.75% to 5.9% and the bracket structure compressed. The corporate income tax is a flat 6.75%. For S corp and PLLC owners, the practical owner tax rate is now the 5.9% top bracket, meaningfully lower than under the prior structure. Returning Montana clinic owners with 2023 history should not assume their go-forward rate matches what they paid before.

Source: Tax Foundation: Montana

No state sales tax

Montana is one of five states with no general state sales tax. Retail revenue inside a med spa, aesthetic supply sales, and DME do not attract Montana sales tax. Local resort area taxes exist in a small number of jurisdictions, but they generally do not apply to medical practices. For clinic owners moving in from sales-tax states, this changes the math on the ancillary revenue lines materially.

Medicaid expansion (Healthy Montana Plan)

Montana expanded Medicaid in 2016 under the Healthy Montana Plan. The expansion population continues to enroll through the state's managed care framework. For independent clinics with a meaningful low-income patient base, expansion changed payer mix in a way that has not fully stabilized. Reporting should split expansion from traditional Medicaid because realization rates and utilization patterns differ.

Source: Montana DPHHS: Medicaid

Certificate of Need (CON)

Montana maintains a Certificate of Need program governing nursing homes, home health, and certain other long-term services. Hospital and ASC expansion is generally less restricted than in classic CON states, but specific services and facility types still require review. Capital planning needs to confirm which services fall under CON before the budget is locked in.

Source: Montana DPHHS: Certificate of Need