HELENA — Seven years after Montana first attempted to add “community engagement” requirements to its Medicaid expansion program, July 1 was the first day the state officially implemented them. Now, most people on Medicaid expansion will need to show they’re working, in school or doing other qualifying activities in order to remain eligible.
(Watch the video for more on how the new requirements will affect Medicaid recipients.)
“The Department is fully prepared for this transition, with trained staff, clear exemption processes, and systems ready to support members,” said Montana Department of Public Health and Human Services Director Charlie Brereton in a statement. “We are focused on helping eligible Montanans keep their coverage while successfully meeting these new requirements.”
The Montana Legislature adopted proposed community engagement requirements during the 2019 session, but never received federal approval to begin enforcing them. Last year, Republicans in Congress passed the federal “One Big Bill,” which required states to start implementing those requirements. While the deadline was Jan. 1, 2027, DPHHS began the process sooner.
Most adults aged 19 to 64 will now have to document 80 hours a month of approved activities – like work, education, training or volunteering – to stay on Medicaid expansion. Some groups will be exempted from the community engagement requirements, including pregnant women, parents or caregivers of children under 14, American Indians, and people with health conditions that affect their ability to work.
You can find more information on the new requirements and documentation on the DPHHS “Changes to Medicaid” website.
DPHHS has announced a three-month “hold harmless” period, lasting through the end of September. During that time, they’ll inform Medicaid recipients who aren’t in compliance with the requirements, but those people won’t immediately lose coverage.
However, some advocates remain worried that people who should remain eligible could still get caught up in the change. Heather O’Loughlin, executive director of the Montana Budget and Policy Center, said the majority of people on Medicaid expansion are working or in school, but that they could struggle with “red tape.”
“What we know is that many folks who would be considered in compliance or meet an exclusion are often the ones who ultimately lose coverage, because they miss the paperwork or face challenges in really reaching the department and getting answers that they need,” she said.
O’Loughlin said, going forward, she’s hopeful the state will be able to get a lot of the information they need to confirm eligibility from existing data – but she believes, for now, much of it is going to fall on the Medicaid recipients themselves.
“The biggest issue here is additional layers of paperwork, that folks who are already facing pretty significant hurdles health-wise are now going to be asked to do more,” she said.
During an interim legislative committee meeting last week, DPHHS leaders told lawmakers they are already able to verify some of the information from other sources – for example, they have access to data that can confirm the exclusion for American Indians or for people already complying with work requirements for benefits like SNAP or TANF. They said they hope in the future to have ways to automatically verify additional categories, like veterans with the highest level of disabilities or caregivers based on their household composition.
As of March, Montana had 207,902 people enrolled in the Medicaid or Healthy Montana Kids programs, including 73,895 adults on Medicaid expansion.
DPHHS says they’ve been reaching out to Medicaid members by mail since March, to explain what’s required of them under the new rules. They’re also encouraging people to sign up with the state’s online portal at apply.mt.gov. There, you can get more information on when your eligibility redetermination will happen and make sure your contact information is updated.
DPHHS also has a Public Assistance Helpline, at 1 (888) 706-1535, and they operate 19 local Offices of Public Assistance around the state.
DPHHS and O’Loughlin both said it’s important for people on Medicaid to stay up-to-date with any notices from the department.
“Folks should really be checking the mail and make sure that they are opening letters from the Department of Public Health and Human Services, reading them carefully, getting help if they have questions,” said O’Loughlin.
