Montana health officials double down on summer launch of Medicaid work requirements

Montana’s state health department says it’s on track to begin checking in July whether Medicaid recipients are complying with new federal work requirements — an overhaul of the agency’s vetting process shepherded by Republicans in Congress and the Trump administration. 

Speaking to state lawmakers during a presentation Monday morning, the top brass of the health department in Gov. Greg Gianforte’s administration clarified that people found to be noncompliant won’t be disenrolled until after October. 

During that three-month grace period, department officials said, beneficiaries of the low-income health insurance program will “receive an informational notice/warning and will not yet be disenrolled.” The agency said that those people will also be referred to job services through the Department of Labor and Industry.

As of December, nearly 43,000 Montana adults were enrolled in traditional Medicaid, which covers low-income people who have disabilities or are pregnant. Another approximately 76,000 were enrolled through Medicaid expansion, the program for low-income adults ages 18 to 65 who don’t otherwise qualify.

While responding to lawmakers’ comments, some health department officials acknowledged that both beneficiaries and the department would undergo a significant shift in protocol.

“That is some of the thought behind, during those first three months, not disenrolling for noncompliance and instead providing education, providing information to the clients and being able to kind of walk them through what the process will look like without disenrolling them at the end,” said Jessie Counts, the health department’s human services director. 

“We anticipate that our staff will be able to keep up, that our technology will work as designed,” Counts continued. 

The department said it is prepared to continue reviewing eligibility every six months, beginning in July, another part of the new federal requirements. 

Historically, Medicaid eligibility in Montana has been primarily based on income, with certain types of disabilities or other conditions, like pregnancy, qualifying people for different categories of the state-federal health insurance program.

The changes passed in House Resolution 1, also known as the One Big Beautiful Bill Act, require beneficiaries to report 80 hours of “community engagement” activities per month. Those activities could include work, school or volunteering.

Lawmakers who supported the legislation, including all four Republican members of Montana’s congressional delegation, have said that work requirements will help tamp down on fraud and abuse of the publicly funded health coverage program.

Opponents have pointed out that the vast majority of Medicaid beneficiaries already work, are in school or are exempted. Critics of the new eligibility checks and frequency say the work requirements are designed to push people off of the rolls, including by making paperwork cumbersome to navigate.

According to a recent Montana Free Press-Eagleton poll, 59% of registered Montana voters said they strongly or somewhat support the increased Medicaid work requirements. In comparison, 37% said they somewhat or strongly oppose those requirements.

At the national level, work requirements for Medicaid beneficiaries have been generally popular in public opinion polling, but pollsters have found that results often depend on how questions are worded and what information respondents are provided. 

In a 2025 poll by KFF, a  national health policy research group, overall support for work requirements dropped to about 35% when told that most adults with Medicaid already work or are unable to work, “and they could potentially lose coverage due to the challenges in providing paperwork to prove it.” Support for the policy was also negatively impacted when respondents were told that it could increase administrative costs for state governments that oversee Medicaid programs.

The Montana state health department said Monday that it has hired 39 staff members to help sift through the new mounds of paperwork and verification checks that members will begin to go through this summer, and that it plans to hire 20 more people in the coming months. 

Those new staffers will also help to identify whether Medicaid recipients are exempt from the new requirements — exemption categories include American Indians, people who have recently been released from prison, people who are pregnant or postpartum and anyone deemed “medically frail,” such as those with substance use disorder or a disabling mental illness.

The department estimated that the additional staffing will cost the state $4.3 million per year. 

State officials said Medicaid beneficiaries will begin receiving notices about the eligibility changes later this month.