Changes to Medicaid

Overview 

On July 4, 2025, the House Reconciliation bill (H.R. 1), also known as “H.R. 1” or the “One Big Beautiful Bill Act,” was signed into law. The law made some changes to the Medicaid Expansion program, which this webpage helps explain.   

H.R. 1 is a new federal law that changes how Medicaid is funded and how some people qualify for and keep their coverage. It is sometimes called the “One Big Beautiful Bill Act” because it combines many health care and budget policies into a single law, including new rules that affect adults covered by Medicaid Expansion.   

Beginning in July 2026, new federal rules from H.R. 1 will change how some Montanans apply for and keep their Medicaid coverage. These changes will mostly affect adults covered through Medicaid Expansion and are intended to increase regular eligibility checks and personal responsibility for staying enrolled.  

A list of Frequently Asked Questions is available for more detailed information.

Please note: The information on this website is current as of March 13, 2026. All information is subject to further guidance provided by Centers for Medicare and Medicaid Services. Guidance is expected by June 2026.  

Goals

  • Improve health, well-being, and financial stability  
  • Help people become more independent and rely less on government support  
  • Increase workforce participation and improve job skills  
  • Use public resources responsibly and increase personal responsibility  

Key changes include

  • More frequent check-ins will help confirm that members still qualify for coverage. 
  • Many adults will participate in "community engagement," such as working or job training. Some individuals may be excused (or “exempted”) due to age, health, or other statuses. 
  • New forms and deadlines will help verify income and program activities to keep benefits active. 

Keep Contact Information Current

To keep coverage active, Medicaid members should carefully read all mail and keep their contact information up to date. Responding quickly to any requests helps ensure benefits continue. The Montana Department of Public Health and Human Services (DPHHS) is always available to provide support.

Eligibility Requirements

To be eligible for Medicaid Expansion, you must show one of the following: 

  • You are meeting the community engagement requirement or 
  • You qualify for an exemption to the community engagement requirement 

Eligibility and compliance is verified during the initial application and during the renewal process, every six months. 

How to Apply

  • Online at apply.mt.gov
  • By phone at 1-800-318-2596
    • This is the DPHHS Public Assistance Helpline, or PAHL  
  • By mail at: 
    • Human and Community Services Division 
      PO Box 202925 
      Helena, MT 59602-2925 
  • In person at a local eligibility office, also known as an office of Public Assistance or OPA 

Overview

Maintaining Medicaid Expansion coverage requires meeting monthly community engagement requirements. These requirements apply to all Medicaid Expansion participants who do not meet the criteria for an exemption. 

Required Hours

If you are aged 19 to 64, you must complete 80 hours each month of approved activities, unless you qualify for an exemption. 

Qualifying Activities

Qualifying activities include:

  • Working at a job 
  • Community service or volunteering 
  • Workforce training or job readiness programs through the State of Montana 
  • Internships or registered apprenticeships 
  • Going to school (college or vocational school) 

Verification

You must prove you are meeting this requirement. Examples of proof may include:

  • Pay stubs from your job 
  • Official letters from your school 
  • Signed volunteer logs showing your hours 

You must continue meeting these requirements throughout your coverage. 

Your completion of community engagement activities may be verified through: 

  • Data matching with other state programs, and/or 
  • Self-reporting online, by phone, by mail, or in person using approved methods 

Community Engagement Exemptions

You may be exempt if you are: 

  • American Indian/Alaska Natives 
  • Children ages 18 or younger 
  • Adults ages 65 or older 
  • Pregnant people and postpartum individuals (up to 12 months) 
  • Parents or caregivers of children under age 13 
  • Parents/caregivers of persons with disabilities 
  • Veterans with disabilities rated as total 
  • People who are medically frail 
  • People enrolled in treatment programs for substance use disorder 
  • Individuals currently incarcerated or recently released 
  • Individuals eligible for Medicare 

Reporting Changes

Members must report changes that may affect eligibility, including: 

  • Citizenship or immigration status 
  • Household composition (marriage/divorce, birth/adoption, someone moves in/out) 
  • Income
  • Employment or education status 

How to Report

You can report changes through: 

  • Online at apply.mt.gov
  • By phone at 1-800-318-2596
    • This is the DPHHS Public Assistance Helpline, or PAHL  
  • By mail at: 
    • Human and Community Services Division 
      PO Box 202925 
      Helena, MT 59602-2925 
  • In person at a local eligibility office, also known as an office of Public Assistance or OPA

Notices

Enrollees will receive timely and adequate notice regarding: 

  • Eligibility decisions 
  • Noncompliance with community engagement requirements 
  • To avoid missing notices, keep your mailing address and contact information up to date in the self-service portal. 

Appeals

All enrollees have the right to appeal adverse actions through a Fair Hearing in accordance with federal Medicaid regulations. The formal notice you will receive a Notice of Adverse Action and includes instructions for appealing. For more information, please visit the  Office of Administrative Hearings webpage.