Montana Accelerates Trump’s Medicaid Work Rules Amid Budget Crisis

Montana is advancing Medicaid work requirements six months ahead of the federal deadline amid a $183 million budget shortfall.

Montana state health officials plan to begin enforcing the new work requirements on July 1, 2026, a significant structural shift in the state’s Medicaid program. This acceleration responds to underfunding and overestimated federal contributions that have strained health service delivery.

The work requirements mandate Medicaid enrollees to prove 80 hours of work or school monthly unless exempt, with eligibility evaluations shifting from annual to every six months. Montana’s Medicaid enrollment has dropped to its lowest point in about a decade following the end of the federal pandemic-era disenrollment freeze. The state faces staffing shortages, with only 39 of 59 new public assistance positions filled by early March, and provider groups express concern about administrative burdens and unclear exemption criteria. The Montana Department of Public Health and Human Services also proposes withholding a 3% Medicaid provider rate increase approved in 2025 to save funds.

Montana will begin dropping enrollees for noncompliance in October 2026, following a three-month grace period.

Given Montana’s rural geography and workforce challenges, these accelerated requirements could intensify pressures on local providers and public assistance infrastructure, potentially affecting access and continuity of care in ways that merit close monitoring.

Montana Hurries To Adopt Trump’s Medicaid Work Rules Amid Budget Woes
By Katheryn Houghton / KFF Health News, The Daily Yonder