HELENA — New rules are set to take effect this summer, tightening the requirements for people of Montana’s Medicaid program to demonstrate they’re still eligible for coverage. Now, advocates are asking state leaders to take steps to minimize the number of people who may lose coverage.
(Watch the video for more on the recommendations advocates are making.)
Starting July 1, Montana will begin implementing “community engagement” requirements, in line with the federal “One Big Bill” passed last year. Most adults enrolled in the state’s Medicaid expansion program will need to work, volunteer or do education, career training or other approved activities 80 hours a month to remain eligible. Some groups are exempted from the requirements, including people 65 and older, pregnant women and parents of children under 13, American Indians and people who are considered “medically frail.”
In a report last year, the Montana Healthcare Foundation estimated that 31,000 Montanans could lose coverage because of the new requirements. Leaders are worried that won’t just include people who are no longer eligible, but also those who are eligible but face administrative barriers to proving it.
“I'm very concerned that people may get lost in the shuffle who have a serious or complex medical illness that isn't either recognized by the state and automatically exempted, or, even if it is, the people just don't have the wherewithal to do the paperwork,” said Aaron Wernham, the foundation’s CEO.
The organization released a new policy brief last week, outlining six recommendations to state leaders on what they can do to give eligible Montanans the best chance to keep their coverage. The suggestions include using existing state data whenever possible to automatically identify people exempt from the work requirements, hiring additional support staff, making required forms as clear and simple as possible and working with providers and other partners so they can help the people they work with.
“It'd be very helpful for the providers to be able to see, for example, templates and copies of the types of notices their patients are going to be getting, so they can prepare and help them navigate those,” Wernham said. “I think there's a lot of community partners out there eager to help the state with this implementation.”
On Tuesday, the Montana Department of Public Health and Human Services announced they were launching an online resource for Medicaid members to get answers about the upcoming changes.
“Our priority is to ensure that Montanans covered by Medicaid Expansion have the information they need to make decisions about their health care,” DPHHS Director Charlie Brereton 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.”
DPHHS said they will be reaching out to all Medicaid members by mail to explain the community engagement requirements. Leaders encouraged anyone covered by Medicaid to check their contact information at apply.mt.gov, to make sure they receive those mailings.
As of December 2025, DPHHS reported more than 210,000 Montanans were enrolled in Medicaid or Healthy Montana Kids, including almost 76,000 adults on Medicaid expansion.
