Montana’s state health department plans to implement new federal Medicaid work requirements by July, as part of changes led by Republicans and the Trump administration. Governor Greg Gianforte’s administration clarified to state lawmakers that disenrollment for noncompliance will not occur until after October.
During a three-month grace period, Medicaid beneficiaries will receive warnings and guidance rather than being disenrolled. They will also be referred to job services through the Department of Labor and Industry to meet the new work requirements.
As of December, traditional Medicaid enrolled nearly 43,000 low-income Montanans with disabilities or pregnancies. An additional 76,000 were part of the Medicaid expansion, which serves low-income adults aged 18 to 65. Health department officials acknowledge significant procedural changes for both beneficiaries and the department.
Jessie Counts, the human services director, stated, “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.”
New federal mandates require recipients to log 80 hours of community engagement, including work, education, or volunteer activities. Supporters, including Montana’s Republican congressional delegation, argue these measures will curb fraud and abuse in Medicaid.
Critics contend the requirements target vulnerable populations, as many already work or are exempted, potentially leading to complicated paperwork and reduced enrollment. A Montana Free Press-Eagleton poll shows 59% of state voters favor increased Medicaid work requirements, while 37% oppose them.
Nationally, opinions on Medicaid work requirements vary, often influenced by question wording and context given to respondents. A 2025 KFF poll indicated support drops to 35% when respondents learn most Medicaid recipients are employed or unable to work.
To manage paperwork and verification, the Montana health department has hired 39 new staff members and plans to hire 20 more, costing the state $4.3 million annually. Notices of the eligibility changes will be sent to Medicaid beneficiaries later this month, explaining exemptions for groups such as American Indians and medically frail individuals.
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