Montana to Enforce Medicaid Work Requirements This Summer, Ahead of Federal Deadline

DPHHS Director Charlie Brereton confirmed Montana will begin enforcing Medicaid work requirements on July 1, months ahead of a federal deadline that gives all states until the end of 2026 to comply, putting nearly 76,000 adults enrolled in the state's Medicaid expansion program on notice that they must document 80 hours per month of qualifying activity or lose coverage.

The requirement targets working-age adults between 19 and 64 who receive coverage through Medicaid expansion. Qualifying activities include employment, volunteering, education, career training, and other approved pursuits. Brereton framed the rollout as an information priority. "Our priority is to ensure that Montanans covered by Medicaid Expansion have the information they need to make decisions about their health care," he said in a statement. "This new website serves as a single source of truth for our members as we begin requiring them to engage in work or work-related activities to be eligible for health coverage."

Not everyone will face the new requirements. Exemptions apply to people 65 and older, pregnant women, parents of children under 13, American Indians, and those deemed medically frail under federal rules. DPHHS has committed to notifying all Medicaid members by mail before July 1. Enrollees should verify their current mailing address in the state's online enrollment system at apply.mt.gov to ensure those notices reach them.

For Lewis and Clark County, the July rollout will hit a safety-net network already under pressure. County social-service caseworkers, behavioral-health providers, and Helena-area workforce programs are expected to absorb a surge in requests from enrollees trying to document hours, claim exemptions, or determine whether the new rules apply to them at all. Safety-net clinics face the added risk of coverage churn, patients cycling off and back onto Medicaid due to missed paperwork deadlines, adding administrative strain at the same time they are absorbing patients displaced by other recent federal health-program changes.

The Montana Healthcare Foundation published a set of recommendations urging DPHHS to invest in well-staffed, multilayered outreach and unambiguous exemption instructions before July 1. Advocates have raised pointed concerns that a state moving faster than federal guidance risks erroneous terminations, particularly among enrollees who qualify for exemptions but cannot readily produce the required documentation.

As of December 2025, more than 210,000 Montanans were enrolled in Medicaid or Healthy Montana Kids statewide. Lewis and Clark County residents receiving Medicaid expansion benefits should watch for a mailed notice from DPHHS, verify their address is current in the state's enrollment system, and contact DPHHS, a local clinic, or a Montana legal-aid organization if they believe they have been wrongly terminated after the July 1 enforcement date.