Montana DPHHS to roll out Trump’s Medicaid work requirements starting July 1

Carly Graf, Missoulian, Mar. 10 2026

Starting July 1, Montanans on Medicaid will have to prove they are employed or enrolled in school in order to maintain health care coverage, making the state one of the first to implement newly-minted federal rules despite widespread pushback from providers and advocacy groups asking officials to hold off.

Last summer’s behemoth budget bill passed by Congress and signed into law by President Donald Trump requires states with Medicaid expansion, the government-funded health insurance for low-income, able-bodied adults, to limit eligibility to people who can prove they’re working or participating in other activities deemed acceptable. Medicaid enrollees must also re-apply twice a year as opposed to annually.

The changes will cull the number of people enrolled in the program — around 13,000 adults over the next two years by Montana health department estimates – including individuals who are eligible but whose applications get gummed up in red tape.

States have until early 2027 to roll out the new rules, according to federal law.

The Montana Department of Public Health and Human Services announced on Monday, however, it intends to implement them six months earlier, even as many questions remain about the state’s readiness to handle the changes.

Early adopter

Montana health officials have said since last summer they want to be quick out of the gate to implement the Medicaid changes baked into H.R. 1, the Trump budget bill. That’s because state law penned last session also includes community engagement requirements, and so they are hurrying to carry out a legislative mandate to execute them as soon as they’re able.

The health department first tried with what’s called an 1115 waiver, which, if approved, would have allowed the state to put its own spin on the work requirements. That proposal included exemptions for foster parents and homeless individuals, among others.

But the Trump administration said it would not approve applications that deviated from the federal bill, prompting the Montana health department to go back to the drawing board with a more straightforward approach known as a state plan amendment, which won’t include those tweaks.

DPHHS has not yet submitted the proposal, but expects it will be approved quickly enough for the July 1 rollout, officials told lawmakers during an interim committee meeting on Monday.

Concerns

A long line of people showed up at the Capitol to express their opposition to the state’s efforts to fast-track the Medicaid changes.

Their main concern: That the health department won’t be able to deal with the surge in applications and inbound questions, and that people will unnecessarily lose health care as a result.

They point to the state’s bungling of Medicaid unwinding, in which Montana earned a national reputation for slow processing times and procedural disenrollments, as proof that their worries are valid.

Atty Moriarty, a Missoula-based pediatrician and president of the Montana Chapter of the American Academy of Pediatrics, said she was “deeply concerned” about the timing of the changes and the potential impact they would have on families that she serves.

Others, including Heather O’Loughlin, executive director of the Montana Budget and Policy Center, asked the state health department to test run its processes before putting peoples’ health care on the line. O’Loughlin pointed out that the state continues to lag behind national averages in how long it takes to approve or deny Medicaid applications, even without the increased complexity of new requirements.

DPHHS expressed confidence that it’s taking the right steps to ensure the rollout goes smoothly.

As of Feb. 26, the department had hired 39 staff members to help with the workload and plans to hire 20 more people. There will be a website, which Jesse Counts from DPHHS described as the “single source of truth” up and running by March 13, and Medicaid enrollees whose cases will be up for review first can expect to receive notices in the mail by the end of the month.

Counts also told lawmakers that the department plans to give people a three-month grace period while they get up to speed on the new system, so the first disenrollments wouldn’t hit until late this year. The department expects it will have evaluated all of the 78,000 Medicaid expansion enrollees by April 2027.

“We anticipate that our staff will be able to keep up and that our technology will work as designed,” she said.

Still, the plan wasn’t enough to assuage the worries of everyone.

Rep. Melody Cunningham, a Missoula Democrat, said she continues to hear from constituents who struggle to navigate the system or even get in touch with someone from the health department who can help them with questions about their Medicaid applications.

“I guess the question is, can we really call people noncompliant if they aren’t receiving calls back?” she said.