Big Sky vote to determine future of local health care in two counties

Big Sky residents in Madison and Gallatin counties will determine the future of community health care in a special-purpose district vote in May.

The ballot initiative aims to create a Big Sky Hospital/Wellness district, which would levy property taxes from within its borders to fund the creation and operation of local healthcare facilities.

Gallatin County Big Sky residents will vote on whether to create the district and, if so, elect a board of trustees. Madison County Big Sky residents will decide whether to withdraw from The Madison Valley Hospital District, also create a Big Sky hospital/wellness district, and elect its board of trustees.

Hospital districts are special Montana districts that cover part, or all, of a county, receive funding from local property taxes, and are governed by a locally elected board of trustees.

The Madison County portion of Big Sky is currently a part of the Madison Valley Hospital District, which encompasses Big Sky and Ennis. Taxes gathered on these properties fund the Madison Valley Medical Center, located nearly 90 road miles away in Ennis.

Many Madison County Big Sky residents don’t use the facilities in Ennis, said Kelly Halmes, the Bozeman Health Big Sky Medical Center administrator. Instead, they receive healthcare at Big Sky Medical Center or in Bozeman, which is geographically closer.

“There’s a significant infrastructure burden, both financial and materially, borne by Big Sky,” said John Loomis, a Big Sky resident in Gallatin County. “The Big Sky Madison County residents utilize the Big Sky infrastructure instead of their own Madison County facilities. Big Sky tax dollars should stay in Big Sky.”

The Big Sky Medical Center, which is the only hospital in Big Sky, does not operate within a hospital district, so none of its funding is derived from local property taxes. Halmes said Bozeman Health has invested nearly $30 million into the center over the decade it has been open.

However, even if the Big Sky Hospital/Wellness District is formed, Halmes said it’s uncertain whether the medical center would receive funding from redistributed property taxes.

“We’re really listening to the community and letting them express their needs. The elected board members will decide how funds are distributed in the new wellness district,” Halmes said.

The May vote is the first of many steps to creating a fully unified Big Sky Hospital/Wellness District, said Daniel Bierschwale, Big Sky Resort Area District executive director. Big Sky voters from Gallatin and Madison counties will decide whether to create two separate wellness districts, which will be joined and governed through an interlocal agreement.

“What’s underway right now is an effort (to) structure the mechanics of setting up the two (districts), and the (districts) themselves have a lot of legwork to do,” Bierschwale said. “We want to ensure that they’re operating congruently with each other and have a real sense of wellness needs within the community.”

The push to withdraw Big Sky Madison County properties from the Madison Valley Hospital District and create the Big Sky Hospital/Wellness District started in December 2023 with a petition mounted by a coalition of Big Sky organizations. The initial petition was struck down by Madison County clerk and recorder Paula McKenzie, who determined only 48 of the petition’s 242 signatures were verifiable.

Montana law states that a petition must receive signatures from at least 51% of residents and landowners within the newly proposed district. McKenzie found only 48% were verifiable. A second attempt was denied by Madison County Commissioners in a 2-1 vote against the withdrawal in January 2025.

However, tides turned in April 2025, when the Montana Legislature passed Senate Bill 260, which allowed the withdrawal from the Madison Valley Hospital District and was the genesis of the proposed Big Sky Hospital/Wellness District to be on the 2026 Big Sky special purpose district ballot.

Additionally, SB260 outlined an eight-year “step-down” reconciliation payment plan designed to ease the fiscal impacts on the Madison Valley Hospital District. A percentage of revenues collected by the proposed Big Sky Hospital/Wellness District will be sent to the Madison Valley Hospital District over eight years.

"In the first year, 70% of the total taxes collected from the Big Sky Wellness district will be payable to The Madison Valley Hospital District," explained Allen Rohrback, the CEO of Madison Valley Medical Center. "It goes to 60% for two years, 40% for two, and 20% for the last two."

Rohrback said The Madison Valley Hospital District plans to use the revenue to bring in specialty services like infusions and GI procedures.

"We're not bringing in those (services) over the...coming years because of the loss of the Big Sky revenue," Rohrback said. "It's the natural progression for any hospital our size to branch out in specialty services which have a better (profit) margin to offset the operating loss of primary care services."

In 2025, the Madison Valley Hospital District received $3,385,873 from tax levies in the Ennis area and Big Sky. Of this, $3,224,503, or 95.2%, is derived from levy districts 28 and 29, which collect property taxes from Big Sky.

While the revenue brought in from the tax levies have helped The Madison Valley Hospital District update their facilities and provide primary care services, Rohrback said the majority of the hospital's funding is derived from other sources.

"Most of our budget is from net patient revenue," said Rohrback. "The other revenue from the hospital district comes from our (Madison Valley Medical Center) Foundation, grants, et cetera."

Supporters of The Madison Valley Medical Center have expressed concerns that the revenue hit could change the way the hospital would operate, but Rohrback said the reconciliation payment plan will give the medical center time to plan with little short-term financial risk.

"We're looking forward to the May election and the creation of the (Big Sky Hospital) District," said Rohrback. "We wish them the best."

Most of the pushback against Big Sky leaving The Madison Valley Hospital District evaporated when SB260 was passed, said Madison County Commissioner Bill Todd.

Because voting on the special-purpose district ballot is limited to Big Sky residents, there is little residents from the rest Madison County can do to influence it.

“I’ve served on the Madison County Mental Health Local Advisory Council since I took office in 2023 and none of the members of the purported wellness district effort have ever come to a meeting,” Todd said. “It’s a curious situation.”

As the vote approaches, the Big Sky Wellness Coalition will host a series of educational events to familiarize voters with the details of the hospital districts, projected community impact, and candidates for the board of trustees.

Voter education events: https://bigskywellnessdistrict.org/.