Montana can now drop Medicaid enrollees who miss work rules
Montana began denying or ending Medicaid coverage this month for expansion adults who don't meet or report new work rules, three months before most states. Nearly 71,000 Montanans are subject to them. Five governors have asked federal health officials to delay the national Jan. 1 deadline.
Montana's grace period for Medicaid work rules ended Oct. 1. Adults covered by the state's Medicaid expansion who don't meet or report the rules can now be denied or removed from coverage, Medical Daily reports. Nearly 71,000 people are subject to them.
The rules ask non-exempt adults ages 19 to 64 to log 80 hours a month of work, volunteering, job training or school. Earning at least $580 a month also counts. Many people are exempt, including caregivers of children under 14, pregnant and postpartum women, and people with medical conditions that limit work.
Paperwork is the worry. NPR spoke with a Missoula teacher-in-training who got a state letter in June that she called "completely confused." It gave two different deadlines. "The notices coming from the department are very, very confusing," state Rep. SJ Howell, a Democrat, told NPR. Senate President Matt Regier, a Republican, sees it differently: "If you're an able-bodied adult that's able to work, you really do need to step up."
Nebraska offers an early look. KFF found about 7% of people renewing coverage there lost it, and 14% of new applicants were denied, Nebraska Public Media reported. About 1,100 people were affected out of roughly 327,000 enrolled.
Other states say they aren't ready. The governors of California, Maine, New Mexico, Oregon and Virginia wrote to Health Secretary Robert F. Kennedy Jr. asking for more time, HealthExec reported. "With less than 100 days remaining before January 1, states cannot reasonably rebuild, test, and validate these systems," the letter said. HHS had not responded.
Here's the background. A 2025 federal budget law requires most states to run these checks by Jan. 1, 2027. Montana, Nebraska and Arkansas started early, NPR reported, though Arkansas won't remove anyone before January. During the 2023 Medicaid unwinding, about 87,000 financially eligible Montanans lost coverage for technical reasons, such as paperwork filled out wrong.
What to do in Montana: Report hours or exemptions at apply.mt.gov or call 1-888-706-1535. Open every letter from the state, and appeal quickly if you get a denial.
What we know: Montana enforcement began Oct. 1, and most states face a Jan. 1 deadline.
What we don't: How many Montanans will lose coverage, and whether HHS will grant any delay.
Where outlets agree Medical Daily and Nebraska Public Media both report that most expansion adults must show 80 hours a month of work, volunteering or school to keep Medicaid.
Where they differ Montana's Senate president calls the rules a fair ask of able-bodied adults, while five governors say late federal changes leave states unable to run the checks accurately by Jan. 1.