New Medicaid eligibility rules add more obstacles for work exemptions
- Jun 9
- 2 min read
Aaron Bolton, MTPR, 06/09/26
Last year, Congress passed a law that requires people on Medicaid to work 80 hours per month. They could also volunteer or get exemptions for going to school, caring for a family member and more.
But all the weedy details about how people would qualify for those exemptions didn’t come out until this month. Top of mind for policy watchers is knowing what kinds of health conditions would qualify for a medical exemption.
Heather O’Loughlin is with the Montana Budget & Policy Center.
“HR 1 directed states to use existing data, which could include medical claims data, to verify exemptions,” O'Loughlin says.
In short, it was widely expected the federal Centers for Medicare and Medicaid Services would provide a list of health conditions that would allow people to stay on Medicaid without working.
“But the rules add a new layer to this exemption,” O'Loughlin says.
There was no exhaustive list. Instead, enrollees will have to submit documentation that the condition they have makes it difficult or impossible to work. Rather than exempting all people who have Parkinson’s disease, those enrollees will have to argue why their condition should exempt them.
It’s not yet clear how states will decide whether a condition meets that threshold, or what kind of documentation people will need to submit.
It was already expected that thousands of people would fall off Medicaid because of difficulty keeping up with the paperwork. O’Loughlin says this will only pour gasoline on that fire.
“I think there’s no question that fewer individuals are going to be able to qualify now for this exemption, which risks a loss of health care coverage for potentially thousands of Montanans.”
Montana health officials have repeatedly said they plan to roll out the new rules July 1, six months before they’re required to do so.
The state health department says the new rules have not changed that timeline.
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