Montana is preparing to reimpose Medicaid work requirements for able-bodied adults as the state confronts a projected $150 million budget shortfall over the next biennium. The policy shift, previously approved but blocked during the Biden administration, is now poised for implementation under signals of federal support from the incoming Trump administration.
The state’s Medicaid expansion has enrolled significantly more beneficiaries than initially anticipated, with approximately 315,000 Montana residents—nearly one-third of the state’s population—currently receiving coverage. State officials estimate that work requirements could reduce enrollment by 15-20%, potentially saving $45-60 million annually in matching funds. However, the policy change threatens to affect between 47,000 and 63,000 current beneficiaries, with rural communities expected to face disproportionate impacts on healthcare access and hospital operations.
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