Montana starts enforcing Medicaid work requirements on Oct 1.
asserted
Montana → start → Oct
Patients are confused
asserted
Patients → confuse → ?
Bethany Zulick went back to school in January to become a high school English teacher.
asserted
Zulick → go → January
Years ago, she taught English as a second language overseas and loved it.
asserted
she → teach → it
"It's so exciting to me to watch someone learn a new word or have that spark of understanding," said Zulick, who lives in Missoula.
asserted
who → watch → Missoula
Zulick knew she could earn enough money as a substitute teacher to make going back to school financially viable — except for the cost of health insurance.
uncertain
going → know → insurance
She didn't want to risk being unable to see her doctor for her allergies or for preventive care.
asserted
She → want → care
The health insurance offered through Montana State University was too expensive, Zulick said, almost as much as her tuition.
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Zulick → offer → tuition
But then she found a solution that allowed her to make the leap: Medicaid.
asserted
her → find → leap
She wouldn't have to pay any monthly premiums.
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She → have → premiums
It worked well for a few months, as Zulick taught by day and took online classes at night.
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Zulick → work → night
But in June, the state sent a letter that she said left her "completely confused."
asserted
she → send → her
She knew Montana was rolling out a system for Medicaid work requirements over the summer, but she thought she wouldn't have to prove she met the requirements until next year, when her Medicaid enrollment came up for renewal.
asserted
enrollment → know → renewal
Yet the letter from the Montana Department of Public Health and Human Services outlining the new requirements gave conflicting information on when Zulick would have to prove she was meeting them.
asserted
she → outline → them
First, it said at her next renewal, which would be sometime next spring.
asserted
which → say → renewal
Lower down, it told her she would have to submit paperwork to prove compliance much earlier — "within 30 days" of the date on the letter, June 26.
asserted
she → tell → letter
She wondered: Was it a boilerplate mass-mailing letter she could ignore, or was her insurance on the line?
uncertain
insurance → wonder → line
All states must implement the new work requirements by Jan. 1, but three states — Montana, Nebraska and Arkansas — have already gotten started.
asserted
states → implement → Jan.
Medicaid advocates worry that the expedited timeline in those states will lead to thousands of people losing coverage because they're confused about the new rules, even if they are eligible for the program — and that Montana may offer a troubling preview of what will happen nationwide next year.
uncertain
what → worry → preview
State health department officials maintain they are well prepared and told state lawmakers they plan to process roughly 5,000 enrollees monthly.
Growing confusion and dwindling help
State Rep. SJ Howell of the Montana House has gotten dozens of calls from confused constituents, specifically about letters like the one Zulick received.
"The notices coming from the department are very, very confusing, and it's very hard to find help figuring out what's going on," said the Democratic legislator, who asked health department leaders about those letters at a hearing in early September.
asserted
who → maintain → September
Letters being sent to enrollees have been updated to be clearer, state health officials told lawmakers at the hearing.
asserted
officials → send → hearing
Medicaid costs are split between the federal and state governments, and states are responsible for administering the program, which provides health insurance for people with low incomes or disabilities.
asserted
which → split → incomes
Under the new work requirements, enrollees must document that they're working, volunteering, or studying 80 hours per month — or they must show that they qualify for one of a range of exemptions, such as being "medically frail" or being the primary caretaker for a family member.
asserted
they → document → member
Montana began with a soft launch of the work requirements in July and gave enrollees until Oct. 1 to comply.
asserted
Montana → begin → Oct.
Critics contend that isn't enough time, because the state hasn't finished setting up new computer systems or hiring the staff it said it would need.
asserted
it → contend → staff
Of the 59 positions, only about 20 were filled, state health department officials told state lawmakers during the Sept. 9 hearing.
asserted
officials → fill → hearing
The state had already hired over half of those workers earlier this summer, but officials said they lost staff to turnover.
asserted
they → hire → turnover
State health officials have said they'll eventually be able to automatically verify that students are enrolled in public universities.
asserted
students → say → universities
However, that computer system isn't expected to be up and running until next year, leaving students like Zulick to track down and submit the correct paperwork to prove their college enrollment.
asserted
system → expect → enrollment
For example, Cover Montana, a nonprofit that helps Montanans fill out such paperwork, lost federal funding last year, going from a staff of 18 to two part-time employees working a phone line.
asserted
Montanans → help → line
The state does operate a helpline, but federal data shows that Montanans stay on hold much longer than the national average and that many callers hang up before they connect with a state employee.
asserted
they → operate → employee
"We were worried about chaos that could be generated by the state rushing," said Aaron Wernham, CEO of the Montana Healthcare Foundation, a nonprofit aimed at improving health in the state.
uncertain
Wernham → worry → state
"Given how little information the state has provided about what they are doing, I'm much more worried about chaos," Wernham added.
asserted
Wernham → give → chaos
Wernham pointed to a similar upheaval in 2023, when states undertook a massive process to redetermine the eligibility of all Medicaid enrollees, after regular eligibility checks were paused during the pandemic.
asserted
checks → point → pandemic
Many Montanans who were financially eligible lost Medicaid coverage for technical reasons, such as incorrectly filling out paperwork — roughly 87,000, according to state data from two years ago.
uncertain
who → lose → data
Even vulnerable Montanans who didn't need to file paperwork, because their coverage should have been automatically renewed, were dropped from the Medicaid rolls, including people who were homeless.
asserted
who → need → people
Long-sought requirements in the state
The Montana Legislature passed a measure in 2019 expressing its desire to add work requirements to Medicaid, but the state didn't have permission from the federal government to move forward until now.
asserted
state → seek → government
Having work requirements creates accountability for people who rely on the social safety net, said Montana Senate President Matt Regier, a Republican.
asserted
Regier → have → net
"In an economy like this, if you're an able-bodied adult that's able to work, you really do need to step up," he said.
asserted
he → work → this
Asked about confusion among enrollees about the rules, Regier responded that the Oct. 1 deadline offered more than enough time to work out the kinks in the new system.
asserted
deadline → ask → system
…and 14 more, not listed.
The Aporia
