Montana kicks off work requirements

Kelly Hooper and Sophie Gardner, POLITICO, 07/01/26

UNCERTAINTY LOOMS — Montana today became the second state to implement Medicaid work requirements months ahead of the 2027 federal deadline, Alice reports.

Unlike Nebraska, which began implementing the rules in May without hiring additional staff, Montana is hiring dozens of workers to manage the rollout and determine which low-income residents remain insured. Its government has also promised that no one will lose coverage until at least October.

But advocacy groups on the ground are already predicting a disaster, noting that the burden is largely falling on Medicaid patients rather than the state to verify their eligibility.

“We anticipate a lot of folks will ultimately lose coverage not because they are not working or not in compliance, but because they simply can’t get through the system,” Heather O’Loughlin, executive director for the nonpartisan nonprofit Montana Budget and Policy Center, told reporters Tuesday. “Enrollees are confused, applicants are confused, and providers, particularly in rural communities, are very worried about what this will look like.”

Montana’s health department did not respond to a request for comment.

Key context: As the state moves forward, uncertainty looms over a key aspect of the program. A coalition of 25 states and the District of Columbia sued the Trump administration this week over the requirement that people with cancer and other chronic illnesses prove their physical inability to work in order to claim an exemption from the rules.

One of the leaders of the lawsuit, North Carolina Attorney General Jeff Jackson, told Alice in an interview that the group is “asking the court to treat this as an emergency.”

“We know that the underlying lawsuit will take months to resolve, but hopefully within a matter of weeks we can get some action from the court here that allows them to put this new rule from CMS on pause, so it doesn’t do unnecessary damage to people,” he said.

The lawsuit argues that the additional requirements for people seeking a “medically frail” exemption violates Congress’ intentions when it crafted the work requirement and sharply diverges from what states say they were promised by the Trump administration.

“We have spent millions of dollars complying with what we were led to believe the new rules would be,” Jackson said. “For CMS to pull the rug at the last minute isn’t just threatening to people with serious illness, it’s also going to result in a lot of wasted tax money as we have to create a new compliance structure.”

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