A grace period is ending, and for many Montanans on Medicaid, that means a deadline they cannot afford to miss. Starting October 1, new work and reporting requirements go into effect. Patients who don't complete the required paperwork or meet community engagement standards risk losing their coverage.
This is uncharted territory. The requirements stem from H.R. 1, the House Reconciliation bill passed by Congress in the summer of 2025, marking the first time work requirements have been permitted under federal Medicaid law. Montana is still working out the details, and that's left plenty of patients with questions.
What's Actually Changing
If you're enrolled in Montana's adult Medicaid Expansion program, the new rule requires you to document 80 hours of work per month for 3 of the last 6 months. Applying fresh as an "able-bodied" adult? You'll need proof of 80 hours worked in the month before you enroll.
Not everyone is subject to this requirement. Exemptions exist for caregivers, family members caring for someone with a disability, parents of children 13 and under, American Indians who qualify under IHS eligibility, individuals determined medically frail, and pregnant or postpartum women.
Here's the part that trips people up: exemption or not, there's paperwork involved either way. Even patients who clearly qualify for an exemption need to document it.
What You Should Do Right Now
Start with your mailbox. The Department of Public Health and Human Services (DPHHS) sends eligibility and renewal notices by mail, and missing one could mean losing coverage without warning. Open everything, even the letters that look routine.
Beyond that, a few practical steps go a long way:
Sign up for email notifications through the self-service portal so you're not relying on mail alone. Keep your address, phone number, and email current — you can update this information at apply.mt.gov, through the self-service portal, or by calling 1-888-706-1535. And log into your account to find your specific Medicaid program and upcoming renewal date. Knowing that timeline gives you room to prepare instead of scrambling.
Documentation matters more now than ever. Pay stubs, timesheets, school enrollment letters, volunteer logs — hold onto all of it. If paper copies aren't practical, a photo or screenshot works fine.
Many patients already meet the requirement without realizing it. Work, school, and volunteering can be combined to reach 80 hours a month. Someone working 60 hours and volunteering 20 hours, for example, would meet the threshold without needing to do anything differently.
And if your Medicaid gets denied or closed and you believe that's a mistake, you have the right to appeal. Montana Law Help has more information on that process.
Local Support for a Statewide Change
Blacktail Health — formerly Southwest Montana Community Health Center — has spent years helping patients across Butte, Dillon, Anaconda, and the surrounding region access the care they need, regardless of insurance status. As a nonprofit community health center, that mission doesn't change with new federal paperwork requirements. If anything, it becomes more relevant.
Patients working through this transition can call 406-723-4075 to reach Holly McCamant, Tina Crummett, or their care manager and schedule time to walk through the documentation process together. Whether you're insured, underinsured, or uninsured, having someone available to answer questions about eligibility, exemptions, or renewal deadlines can make a confusing process considerably more manageable.
This kind of support reflects what community health centers were built to do. Blacktail Health offers primary care, dental services, retail and clinical pharmacy, behavioral health, and care management under one roof, with a sliding fee scale available for patients who qualify. Comprehensive healthcare only works if patients can keep their coverage, and that's exactly the gap this outreach is meant to close.
Don't Wait Until October 1
Deadlines like this don't bend for uncertainty. If you're on Medicaid Expansion or applying as an able-bodied adult, take the time now to check your renewal date, gather your documentation, and confirm your contact information is current with DPHHS.
If you have questions about how these changes affect your coverage, call Blacktail Health at 406-723-4075 to schedule an appointment. Staff can help you understand what's required, track down the right paperwork, and keep your Montana healthcare coverage intact through this transition.
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