President Donald Trump’s so-called One Big Beautiful Bill requires states to impose work requirements for those on Medicaid expansion. The deadline to do so is the end of 2026, but the state wants to impose those requirements sooner.
People 19 to 64 years old will be required to work 80 hours per month. There are a range of exemptions for disabled people, tribal members, college students and others.
The state also wants enrollees to pay monthly premiums based on how long they’re on Medicaid expansion.
The state estimates 65% of enrollees meet the standards or are exempt. However, a recent Montana Department of Labor and Industry report estimated that figure to be greater than 90%.
Health economist Bryce Ward did an analysis that had a similar finding.
“The expectations of any benefit to anybody from this are pretty much zero,” he says.
Ward says studies have shown work requirements for public programs don’t boost work participation. He also says the state likely won’t save money, because of the additional paperwork.
Experts worry that many people won’t be able to keep up with the additional paperwork, even if they are working. KFF, a non-partisan health policy group, estimates 34,000 Montanans could lose coverage.
Many public comments on the proposal asked the state to delay the new rules. They cited the thousands of enrollees that lost coverage due to paperwork errors and backlogs when the state redetermined eligibility for all enrollees after the pandemic.
The state said that process was “distinctly different than what is being contemplated.”
