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 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 June 12, 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 “excluded”) 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 exclusion to the community engagement requirement

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

How to Apply

  • Online at apply.mt.gov
  • By phone at 1-888-706-1535
    • 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 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 
  • Community service or volunteering 
  • Workforce training or job readiness programs through the State of Montana 
  • Going to 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 Exclusions

The following people may be excluded:

  • American Indian/Alaska Natives
  • Former Foster Youth​ under age 26
  • Inmates of a public institution
  • People with a medical condition or health needs that impact ability to work or do other community engagement activities
  • Compliant with SNAP/TANF work requirements
  • Caregivers for children under age 14 or persons with disabilities
  • People in a drug or alcohol rehabilitation or treatment program
  • People who are pregnant or postpartum (up to 12 months)
  • Children aged 18 or younger​
  • People eligible for Medicare
  • People recently incarcerated​ within the past 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
    • Person or dependent who must travel outside of their community for medical services for a serious or complex medical condition

Additionally, you may be excluded if you are experiencing one of the following short-term hardship events:​

  • Receive inpatient hospital services, nursing facility services, services in an intermediate care facility for individuals with intellectual disabilities, inpatient psychiatric hospital services, or similar services ​
  •  Reside in a county where there is an emergency or disaster declaration​
  • Reside in a county that an unemployment rate greater than the lesser of 8 percent or 1.5 times the national unemployment rate​
  • You or your dependent must travel outside of your community for an extended period to receive medical services necessary to treat a serious or complex medical condition that are not available within the community you live in

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
    • 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.