Adults covered by Montana's Medicaid expansion who do not meet or report new work requirements can now be denied or removed from coverage after the state's three-month grace period ended Oct. 1. Nearly 71,000 people are subject to the rules, NPR reported.
The requirement took effect July 1, but no one was denied or disenrolled for noncompliance from July through September. Starting in October, enrollees who do not meet the requirement "may be denied coverage or disenrolled," according to the state's Medicaid changes FAQ.
Most states will not enforce similar rules until Jan. 1, 2027, when a federal law makes them mandatory. Montana families are among the first to find out how the paperwork works in practice, and some lawmakers and advocates say the notices are hard to understand.
Rules Now Carry Consequences
Montana requires non-exempt expansion adults ages 19 to 64 to complete 80 hours a month of work, volunteering, job training, or school. Earning at least $580 a month also meets the requirement, and attending school at least half-time, such as six college credit hours, qualifies.
The state reviews compliance when people apply and when they renew coverage. Starting in January 2027, most people will renew every six months instead of once a year.
"We are committed to ensuring eligible Montanans maintain coverage while meeting requirements, and we will continue to monitor implementation closely," Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, told NPR.
Montana is not alone. Nebraska began its requirement in May, and Arkansas started a soft implementation in July but will not disenroll anyone before Jan. 1, 2027, according to the KFF work requirements tracker. Georgia has run a separate waiver program since 2023.
Exemptions Cover Many Enrollees
Many Montanans will not have to report hours. The state's June announcement lists exemptions for American Indian and Alaska Native people, caregivers of children under 14 or of people with disabilities, former foster youth under 26, and pregnant and postpartum women for up to 12 months.
People with medical conditions that affect their ability to work and veterans with a total disability rating are also exempt. So are people who meet TANF work requirements and people who receive SNAP and are subject to its work requirements. The list also covers people recently released from incarceration and people in drug or alcohol treatment. Enrollees should confirm that the state has their exemption on file.
The rules apply to the expansion group, which covers adults with incomes up to 138% of the federal poverty level. Children, older adults on Medicare, and people with disabilities covered under other Medicaid categories are not part of this requirement.
Confusion Has Followed the Notices
Some lawmakers and advocates say the state's letters are hard to follow. "The notices coming from the department are very, very confusing, and it's very hard to find help figuring out what's going on," said state Rep. SJ Howell, a Democrat.
Akeiisa Coleman, who provides Medicaid analysis for the Commonwealth Fund, told NPR that "Montana is going to be an example for what we might see nationally as things roll out."
Supporters see the rules as reasonable. "In an economy like this, if you're an able-bodied adult that's able to work, you really do need to step up," said Senate President Matt Regier, a Republican.
Aaron Wernham, chief executive of the Montana Healthcare Foundation, said, "Given how little information the state has provided about what they are doing, I'm much more worried about chaos."
Paperwork has cost Montanans coverage before. About 87,000 financially eligible Montanans lost coverage during the 2023 Medicaid unwinding for technical reasons, such as incorrectly filled-out paperwork, NPR reported. Some students must also track down their own school records, because automatic enrollment checks with public universities are not expected until next year.
Steps Enrollees Can Take Now
Montanans on expansion Medicaid can report work hours, income, school enrollment, or exemptions online at apply.mt.gov or by calling the state's Public Assistance Helpline at 1-888-706-1535. Keeping pay stubs, volunteer logs, school schedules, and doctor's notes in one place makes renewals easier.
Anyone who receives a denial or disenrollment notice can appeal using the instructions on that notice. Acting quickly matters, since appeal deadlines are printed on the letter. People who lose coverage may also want to ask about other options, such as marketplace plans.
Enrollees should open every letter from the state and keep their mailing address, phone number, and email up to date. Missing a request for information can cost people coverage even when they qualify.
Clinics, hospitals, and tribal health programs may also be able to help patients fill out forms or document exemptions. People with a medical condition that limits work can ask their doctor for documentation now, before a renewal letter arrives.
Federal rules under the 2025 budget law will require similar checks in most states by Jan. 1, 2027. MedicalDaily previously reported on early confusion in Nebraska, which began its requirement in May. Montana's experience over the next few months may offer an early look at what other families should expect.
Key Questions Answered
What changed in Montana on Oct. 1? The grace period ended, so expansion enrollees who do not meet or report the work requirement may now be denied or disenrolled.
How many people are affected? Nearly 71,000 Montanans are subject to the rules, according to NPR.
What counts toward the requirement? Eighty hours a month of work, volunteering, job training, or school, or earning at least $580 a month.
Who is exempt? Exemptions include American Indian and Alaska Native people, caregivers of children under 14 or people with disabilities, pregnant and postpartum women, and people with medical conditions that affect their ability to work.
How do enrollees report? Online at apply.mt.gov or by calling 1-888-706-1535.
Can a denial be appealed? Yes. Instructions and deadlines are included on the notice.
Published by Medicaldaily.com
