Montana will implement Medicaid work requirements on July 1, 2026, becoming the second state after Nebraska to require enrollees to prove they are working, attending school, or volunteering at least 80 hours per month to maintain coverage. The start date aligns with the beginning of Montana’s new state budget year and comes six months ahead of the federal deadline established under the One Big Beautiful Bill Act.

The federal law, passed after Montana lawmakers underfunded the state health agency in the previous year’s budget, mandates biannual verification of enrollees’ work status or exemptions. Implementing the verification process will require time and resources from states, and Montana officials are preparing by scanning existing data to automatically confirm compliance and expanding their public assistance team.

Montana health officials must resolve a Medicaid-driven spending deficit by the July 2026 deadline. A proposed budget fix includes delaying scheduled rate increases for healthcare providers that were due the same day. Clinicians report they already struggle to afford hiring staff due to low Medicaid payments, and they attribute growing waitlists for care to those payment levels.

State data from recent years shows Medicaid enrollees in Montana often face long waits to access public assistance, and many lose coverage during renewal due to paperwork issues. Officials are also awaiting federal guidance on exemptions for vulnerable populations under the new work rules.

"Our concern is, is the department ready? Does the capacity exist for all this to be done right and ensure that patients don’t pay the price?" said Jean Branscum, CEO of the Montana Medical Association. Joan Alker, a Georgetown University researcher focused on health coverage, said, "States are the ones that are gonna have to do the dirty work of implementing cuts."

The One Big Beautiful Bill Act is expected to reduce federal Medicaid spending by nearly $1 trillion over 10 years. It also shifts more food assistance costs to states and includes tax breaks that could affect state budgets. Montana now faces the task of implementing these changes with fewer resources and increased administrative demands.