GREAT FALLS — Montana is preparing to roll out new Medicaid work requirements this summer, six months before the federal deadline, raising questions about how the changes will impact patients, providers, and the state’s healthcare system.
Madison Collier reports - watch the video here:
The Montana Department of Public Health & Human Services (DPHHS) plans to begin implementing the requirements on July 1, 2026. A federal law sets a broader deadline of January 1, 2027, for similar changes nationwide.
Key work requirement changes:
- Most adults must complete 80 hours per month of work or approved activities
- Activities can include employment, education, job training, or community service
- Some individuals are exempt, including caregivers, students, and people with disabilities
- Recipients may need to submit documentation to verify compliance
- Those who do not meet requirements could lose Medicaid coverage
Under the policy, some Medicaid recipients will be required to show they are working, attending school, or participating in other qualifying activities in order to maintain their coverage.
State officials have said the goal is to encourage workforce participation and support the long-term sustainability of the Medicaid program.
Some lawmakers are raising concerns about the state moving forward ahead of the federal timeline.
State Representative Jane Weber of Great Falls said the earlier start date creates uncertainty, particularly because final federal guidance has not yet been fully released.
“The state is choosing to implement these work requirements six months ahead of when they’re actually required… and we don’t even have the full federal rules yet,” Weber said.
She said that a lack of clarity could make it difficult for recipients to understand what is expected of them.
“People don’t even know how to comply right now… and the state doesn’t fully know what those requirements will be yet either,” she said.
Under the new requirements, recipients who do not meet eligibility standards could lose their coverage.
The policy also includes periodic eligibility checks, which could affect how consistently individuals remain covered throughout the year.
Healthcare providers across Montana are also watching the rollout closely.
In a statement, Benefis Health System said changes to Medicaid eligibility, along with rising insurance costs, could lead to an increase in uninsured patients.
Here is Benefis CEO John Goodnow’s full statement:
The impact of the Big Beautiful Bill Act on Benefis Health System is additional financial pressure due to increasing numbers of uninsured patients and increased charity care and bad debt expenses at the very time when the organization’s finances were already under pressure.
The Big Beautiful Bill Act had 3 major provisions that impact Benefis Health System, as well as all of Montana’s other hospitals and hospitals across the nation:
Not renewing the subsidies (which expired in early 2026) for those getting health insurance coverage via the Marketplace plans that were part of the Affordable Care Act. The result of the loss of subsidies is that the cost of insurance rises, in some cases dramatically, which results in some simply dropping their coverage and becoming uninsured.
New work requirements and eligibility standards for those covered by Medicaid, particularly Medicaid Expansion, that will reduce the number of people covered and again lead to more uninsured. These new provisions go into effect nationally in early 2027, but Montana applied to the federal government to implement these provisions early in Montana, in July 2026.
When the Big Beautiful Bill Act was being debated in Congress it was recognized that the above two factors would further stress hospital/health system finances and that resulted in a provision for rural hospitals: the Rural Health Transformation Program (RHTP). Congress added $50 billion over a 5-year period with the intent of improving rural health and financially helping small Critical Access Hospitals.
Hospitals in Montana, particularly in rural areas, often operate with narrower margins compared to larger systems, making shifts in coverage levels especially impactful.
At the federal level, lawmakers have acknowledged the potential strain these changes could place on healthcare systems.
A provision known as the Rural Health Transformation Program includes $50 billion over five years aimed at supporting rural hospitals and improving access to care.
Many of Montana’s healthcare facilities fall into the category of critical access hospitals, which could be among those impacted by both the policy changes and the additional funding.
Weber emphasized the importance of clear and consistent communication as the state moves forward with implementation.
State officials say Medicaid recipients will begin receiving information about the changes ahead of the July rollout.
As the implementation date approaches, both policymakers and healthcare providers say the focus will be on ensuring patients understand the new requirements and are able to maintain coverage if they qualify.
