By Jen Clancey STAFF WRITER
Six months ahead of the deadline, Montana adopted new federal rules about the Medicaid expansion program on July 1. The result could lead to 31,000 Montanans losing Medicaid coverage, according to an analysis by Montana Healthcare Foundation.
The Medicaid expansion program was adopted by Montana to cover individuals earning low incomes up to 133% of the federal poverty level. After being the second state to adhere to the requirements in the July 2025 One Big Beautiful Bill, Montanans on the expansion program are now required to document and submit volunteer, education and work hours, and will eventually need to redetermine their coverage every six months. Bozeman’s Human Resource Development Council worries that the complicated paperwork associated with the change will further strain struggling customers, potentially leading to lost coverage.
“Housing is vulnerable. All your things are vulnerable, and you get that last lifeline cut off, it can be really scary,” Heather Grenier, HRDC CEO said.
Sarah Gaither, the executive director of the Big Sky Community Food Bank, noted Medicaid cases are so complex that she can only help five people file at a time.
“I can’t stress enough how difficult and time-consuming the actual paperwork is,” Gaither said.
An insurance coverage organization called Cover Montana used to visit the BSCFB to assist in Medicaid applications, but in 2025, they lost all but two of their staff to federal funding cuts. Now HRDC is trying to fill the gaps through partnerships with other organizations.
“The challenge and the increasing need for that family, if they lose those benefits, significantly outweighs the work that we could do on the prevention side,” Grenier said. To remain on Medicaid expansion, customers need to record 80 hours of allowable volunteer work or education each month and prove it’s been done. This can be done by submitting signed volunteer logs, pay stubs or official letters from a school. The redetermination process, which decides whether a person stays covered, will start running on a six-month cycle beginning in 2027.
Hope Finch, a community worker for Big Sky’s Wellness In Action, described how clients could be impacted by Medicaid cuts and new regulations.
“It’s kind of, unfortunately, a perfect storm of some really challenging dynamics,” Finch said.
The new rules regarding Medicaid expansion present hurdles for people without homes, or who live in more rural places. Montanans on the program need to make sure they’re checking their mail regularly, meeting filing deadlines and building a record of the required hours.
HRDC is organizing with partners to help people stay up to date on their paperwork. Some of that includes planning how an individual without a P.O. Box can get mail about their Medicaid status, and educating people on the best ways to get in touch with the Montana Office of Public Assistance for questions and concerns—often the most effective way is to email. To solve for physical mail, the BSCFB has been accepting mail on behalf of some of their customers.
Both Grenier and Gaither are concerned about the mental health of their customers due to the amount of collaborative work it will take to stay on Medicaid.
“They don’t want to feel … that they’re a burden,” Grenier said. “It just reinforces a really negative mindset, that they haven’t earned this benefit or they don’t have a right to these things.”
Gaither described what she has seen as “despair.”
The Montana Legislature could address some of the problems residents on Medicaid face when it convenes in 2027. For now, organizations are looking for ways to support people adjusting to federal-state healthcare changes.
