By Lillian Poulsen, Digital Organizer
On July 1, Trump’s Medicaid work requirements went into effect in Montana. However, the state won’t start enforcing this rule until October. Montana is the second state to implement the law, following Nebraska’s adoption in May.
Under the House Reconciliation Bill (H.R. 1) or the “One Big Beautiful Bill Act,” signed into law on July 4, 2025, states must require people on Medicaid to work about 80 hours per month, earning a monthly income of $580. The law requires states to introduce work requirements by January 1, 2027.
Who’s affected?
The decision applies to people under Medicaid expansion – those who earn up to 138% of the federal poverty level – between the ages of 19 and 64. The state will issue a notice if a person hasn’t filled out the necessary forms, and they will remove people from Medicaid rolls after 30 days.
The Congressional Budget Office estimates that millions of people will become uninsured. Montana expects between 31,000 and 38,000 Montanans will lose their Medicaid coverage.
This will disproportionately affect low-income, rural individuals, and people of color who are more likely to use Medicaid.
In Montana, about 65% of Medicaid members live in rural areas. Medicaid Expansion insures 95,000 low-income people in Montana. Fortunately, the work requirements don’t apply to Indigenous Montanans, who make up 16% of Medicaid members.
Exemptions
Children, pregnant people, and disabled people who receive Social Security payments don’t have to meet the new requirements, according to KFF Health News. Other people eligible for exemptions are people who have been incarcerated in the last three months and former foster kids under 26 years old.
Instead of working, people can volunteer or get an exemption if they are a student or caring for kids under 14 or for someone with a disability.
Congress created exclusions for individuals if they meet a “medical frailty” requirement, which is tied to their ability to work. The law includes five categories: people who are blind or disabled; have a physical, intellectual, or developmental disability that limits their ability to perform one or more activities of daily living; have a substance use disorder or a “disabling” mental disorder; and those with “serious or complex” medical conditions. States can’t add categories or diagnoses to this definition.
To receive a medical frailty exemption, individuals must fall within one of the five categories and prove that their condition significantly impairs their ability to work or participate in community engagement activities.
It’s not clear who will be approved and which documentation is required, but the state is allowed to contact a person’s health care provider to confirm if they listed a medical exemption.
States can also allow short-term hardship exceptions for people who live in counties with high unemployment rates, those experiencing natural disasters, individuals admitted to a hospital or nursing facility, or those who must travel outside their communities to obtain medical care.
Every six months, Montanans will be required to re-enroll in Medicaid. Before this new rule, Montanans only needed to verify Medicaid eligibility once a year.
Fighting back in courts
Americans won’t accept these work requirements without a fight. Massachusetts Attorney General Andrea Joy Campbell and 26 other states filed a lawsuit against Trump for the Medicaid work requirements.
When the Centers for Medicare and Medicaid Services released their rule, effective July 31, they made it more difficult for vulnerable people to access Medicaid. Massachusetts said this rule would put a strain on their health care system.
Progressives are hopeful that this is one lawsuit of many challenging these work requirements.
Creating hardship
This is yet another attempt by the Trump administration to make health care inaccessible, unequally targeting low-income, rural people, and Indigenous people in Montana.
The federal government doesn’t want to pay for Americans’ health care. Trump and his administration want to reduce spending by pushing costs onto providers and patients.
Health care is already expensive for providers due to administrative burdens, labor, and drugs and other supplies. Montana has 50 Critical Access Hospitals and 62 rural health clinics that have more difficulty keeping up with these costs.
Patients struggle to afford health care, which is why Medicaid exists. Making it more difficult to access or taking away this essential service is an attack on Americans. Trump is making it more expensive to live in America.
What you can do
Give a shit about what’s happening to Medicaid.
Make your voice heard by submitting formal public comments when there are open periods. Work with advocacy groups to ensure more exemptions for people who need them.
Help inform the public, especially Medicaid members, about what’s going on. Do what you can to make sure more legislation isn’t passed to harm your neighbors.
We have nothing if we don’t have each other.