Advocates warn Medicaid work rules could cut coverage in Montana
Montana’s new Medicaid work rules took effect July 1, and advocates in Helena warned that paperwork and delays could cut off coverage for thousands.
Advocates packed the Montana State Capitol rotunda in Helena on Tuesday to warn that Montana’s new Medicaid expansion work rules could knock people off coverage or trap them in paperwork just to keep it. The change now applies to most adults ages 19 to 64 on Medicaid Expansion who are not exempt, and it reaches new applicants who apply on or after July 1.
Under the rules, most members must document at least 80 hours a month of work, volunteering, school, or another approved activity. Pregnant women, parents or caregivers of children under 14, American Indians, and people with health conditions that limit work are exempt. Even so, the real danger is not just whether someone qualifies, but whether they can prove it in time before coverage is interrupted at redetermination.
Catalyst Montana organized the rally, and the group’s senior health and economic justice organizer urged the state to rely on information it already has whenever possible and to make the rollout more transparent. An in-home caregiver from Missoula said the people she cares for need healthcare, not more paperwork. A Helena-based assistance coordinator said the process could be painful to navigate even for someone who works with the system daily.
Montana Medicaid expansion covered about 76,000 people at the end of 2025, and compliance will be checked at the next redetermination.
The Department of Public Health and Human Services went live with the policy on July 1 and has set up a Changes to Medicaid website and a Work4DPHHS.com information hub with the rules. In a June 30 release, DPHHS Director Charlie Brereton said the department was “fully prepared for this transition,” with trained staff, clear exemption processes, and systems ready to support members.
Montana first tried to add Medicaid expansion community engagement requirements in 2019 through House Bill 658 and a HELP waiver amendment, but the Centers for Medicare & Medicaid Services declined the waiver in 2020. The state is moving six months earlier than the federal timeline would otherwise require, and advocates want detailed operational data so hospitals, clinics, and nonprofits can help people avoid losing coverage for procedural reasons.
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