Changes to Medicaid

Please Note: The information on this website is current as of Aug. 6, 2026.

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 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 additional guidance about the community engagement requirement, exclusions, reporting, verification, and other Medicaid Expansion updates.

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 enrolled in Medicaid Expansion may need to meet the community engagement requirement through qualifying activities such as work, education, volunteer service, or job training. Some individuals may be excluded due to age, health, or other status.
  • Updated forms and verification processes help confirm community engagement activities, exclusions, and other eligibility information when needed. 

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 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 exclusion to the community engagement requirement

Eligibility and compliance are verified during the initial application process and during the redetermination process. DPHHS will first check existing data sources before requesting additional verification.

How to Apply

Online (Self-Service Portal)
Paper Application (Mail or in Person) 
  • By mail:
    Human and Community Services Division     
    PO Box 202925 
    Helena, MT 59602-2925 

*Note: Supporting documentation and appendices are optional at the time of application.

By Phone

  • Call the Public Assistance Helpline (PAHL) at 1-888-706-1535

Overview

Some individuals enrolled in Medicaid Expansion must meet the monthly community engagement requirement unless they are a specified excluded individual. This requirement applies to all Medicaid Expansion participants who do not meet the criteria for an exclusion.

Required Hours

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

Qualifying Activities

Qualifying activities include:

  • Working at a job (paid or in-kind) 
  • Community service or volunteering with a not-for-profit organization
  • Participating in an approved state or federal workforce training or job readiness program
  • Doing an internship or apprenticeship
  • Going to school
  • Combining activities (for example, you could work 60 hours and complete 20 hours of community service)

Verification

You must prove you are meeting this requirement.

Examples of documentation, if requested by DPHHS, may include:

  • Pay stubs from your job 
  • Official letters from your school 
  • Signed volunteer logs showing your hours 
  • Other documentation requested by DPHHS

You must continue meeting the requirement throughout your coverage. 

Your completion of community engagement activities may be verified through: 

  • Existing electronic data sources or data matching with other state programs, and/or
  • Self-reporting online, by phone, by mail, or in person using approved methods
  • Additional supporting documentation, if requested by DPHHS

At the time of application, the community engagement requirement forms (Appendix A and B) and supporting documentation are optional. DPHHS will first attempt to verify that you meet this requirement or qualify for an exclusion using existing data sources. If verification cannot be completed, you may be asked to provide additional documentation.

Similarly, at redetermination, DPHHS will first attempt to ex parte you using existing data sources. If verification cannot be completed, you must complete the community engagement requirement forms (Appendix A and B) and provide supporting documentation to maintain your coverage.

Community Engagement Exclusions

When applying or renewing coverage, you must demonstrate that you meet the community engagement requirement unless you qualify for an exclusion:

  • At application: The month before your new application
  • At redetermination: At least 3 months since your last redetermination (the months do not need to be consecutive)

If you believe you may qualify for a Medically Frail exclusion, visit the Medically Frail Guidance for additional guidance. If you are unsure whether you qualify, talk with your health care provider.

There are two different ways you may be excluded from the community engagement requirement. Specified exclusions apply based on your current circumstances. Exceptions and short-term hardships temporarily satisfy the requirement for the months they apply:

  • If you are a specified excluded individual, the requirement does not apply to you at all.
  • If you have an exception or a short-term hardship, you are treated as meeting the requirement only for the months that the exception or hardship applies to you. At redetermination, if you cannot show that you had an exception or short-term hardship for three of the months since your last redetermination, you will need to meet the community engagement requirement through approved activities to keep your Medicaid coverage.

Specified Exclusions apply to your current situation. You may be excluded if one or more of the following options apply to you at the time of your application or redetermination:

  • American Indian/Alaska Native
  • Former Foster Youth under age 26 who were on Medicaid and in foster care when they turned 18
  • Inmate of a public institution (e.g., jail, prison)
  • People with a medical condition or health needs that impact their ability to work or do other community engagement activities (for more information on this exclusion, please reference the Medically Frail webpage)
  • Parent, guardian, caretaker relative, or family caregiver of a dependent child under age 14 or a disabled individual
  • People in a drug or alcohol rehabilitation or treatment program
  • People who meet TANF work requirements, or receive SNAP and are subject to SNAP work requirements
  • Women who are pregnant or postpartum (up to 12 months)
  • Veterans with a total (100%) disability rating

Exceptions and short-term hardships may fulfill part or all of the community engagement requirement for the months that they apply to you:

  • Children aged 18 or younger
  • People eligible for Medicare
  • People incarcerated in the last three months
  • People experiencing the following short-term hardships:
    • Receiving inpatient services
    • Residing in a county with an emergency disaster declaration
    • Residing in a county with high unemployment (Note: Montana will not be implementing the high unemployment exception at this time)
    • Person or dependent who must travel outside of their community for medical services for a serious or complex medical condition 

At application, you must show that the exception or hardship applied for the month before your new application. DPHHS will first review existing data sources and may contact you if additional verification is needed.

At redetermination, you must show that the exception or hardship applied for at least 3 months since your last redetermination. The months do not need to be consecutive. If you have an exception for only one or two months, you must complete the remainder of the community engagement requirement by reporting qualifying activity hours.

Due to new requirements in H.R. 1, clients on Medicaid Expansion will now be redetermined, or re-checked for eligibility, every six months instead of annually. This does not apply to individuals who are American Indian/Alaska Native.  This change will be effective as of January 1, 20267.

Starting in January 2027, Montana will begin processing cases to align with this schedule. That means that some individuals will be redetermined before their current certification period ends. CMS allows states to "pull forward" cases that are six months into their certification period. CMS requires states to provide at least 10 days notice for a change in certification period. DPHHS intends to provide notice 30 days in advance.

It is important that individuals and families keep their addresses up to date and open any mail from DPHHS so they do not miss any communications about changes to their redetermination deadlines.  

H.R. 1 also included changes that limit federal funding for Medicaid coverage for certain categories of qualified noncitizens. ​Once this change is implemented on October 1, 2026, states will only receive federal funding for Medicaid coverage for US citizens and US nationals, legal permanent residents (e.g., green card holders), Cuban/Haitian entrants, and COFA migrants. ​This means that other groups of qualified noncitizens, such as asylees and refugees, will no longer be eligible for Medicaid. 

H.R. 1 also changes retroactive coverage for the Medicaid Expansion population from 3 months to 1 month, effective January 1, 2027. ​For people in other eligibility groups, retroactive coverage will change from 3 months to 2 months. ​Individuals must still request retroactive coverage.  Additionally, individuals must meet all eligibility requirements for the retroactive period.

Beginning October 1, 2026, clients who apply for Montana Medicaid coverage under the Medicaid Expansion population through the Federally Facilitated Marketplace (FFM) will be subject to the community engagement requirement. The FFM will not evaluate applications for the community engagement requirement and may provide messaging indicating that the client has been approved for the financial eligibility components. DPHHS will check all FFM eligibility determinations to verify if the individual has met the community engagement requirement or has an exclusion. CMS is working to adjust FFM messaging and processes by January 1, 2027. 

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 1-888-706-1535
    • Call the DPHHS Public Assistance Helpline (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 is a Notice of Adverse Action and includes instructions for appealing. For more information, please visit the  Office of Administrative Hearings webpage.