Montana’s Department of Public Health and Human Services submitted a Section 1115 Waiver Tuesday, which, if approved, would allow the state to implement community engagement requirements for Medicaid eligibility ahead of the 2027 deadline imposed by the passage of the One Big Beautiful Bill Act.
“The H(ealth and Economic Livelihood Partnership) Demonstration waiver will require working-age, able-bodied adults enrolled in Medicaid to actively participate in their health care by paying premiums and contributing to their communities — either by working, pursuing job training or education, or engaging in community service activities that enhance their employability,” Gov. Greg Gianforte (pictured below) wrote in a letter to Robert F. Kennedy Jr., the secretary of Health and Human Services.
Montana would see community engagement requirements come down the pike once the waiver is approved by the Centers for Medicare & Medicaid Services. Those requirements would mandate enrollees aged 19-64 to participate in at least 80 hours of community engagement — such as work, community service, work programs or educational programs — per month, with some exceptions. Premiums will also increase based on the length of time someone is enrolled in Medicaid.
The waiver will remain in place for five years if approved, according to a Monday press release from the governor’s office.
It’s estimated 17.5% of Medicaid expansion enrollees will lose coverage thanks to the state’s new community engagement requirements. An additional 1.5-2.5% of enrollees will also be disenrolled because of premiums. More than 76,000 people are enrolled in Medicaid expansion in Montana, including 7,165 in Flathead County, per May figures from the state’s health department.
Before the state’s submission of the waiver, it held three meetings for feedback: two for the public, and one for tribal consultation. Tribal leaders raised concerns about increased bureaucracy and requirements. Previous Flathead Beacon reporting cited concerns from a lawmaker about the speed at which the department is moving with the waiver. Public comments — of which the state logged nearly 500 — expressed opposition to community engagement policies and cost sharing for Medicaid recipients, the waiver application notes.
“Given that this Demonstration seeks to implement both state and federal law, DPHHS is not revising the key components of this Demonstration application based on public comment at this time,” the waiver application reads.
Montana’s desire to enact a community engagement requirement for Medicaid coverage isn’t new. It’s been baked into legislation in the state since 2019, but Biden administration priorities prevented its enactment.
The waiver’s text acknowledges Montana’s law doesn’t align perfectly with the One Big Beautiful Bill Act, but says “the state is committed to working collaboratively with the Trump administration to develop a program that aligns with Montana’s unique needs while remaining fully compliant with the new federal law.”
The state has continued to pass Medicaid expansion since 2019 — most recently, in this spring’s legislative session, thanks to a bipartisan coalition of Democrats and some Republicans. The issue has proved popular among Montana voters. The Montana Free Press-Eagleton poll included 900 respondents and found 77% of them either strongly or somewhat supported Medicaid expansion. That figure included participants who identified as Democrats, Republicans and independents.
While the governor and director of the state’s health department supported the waiver’s submission, legislative Democrats opposed it in a July letter.
“Instead of increasing labor participation, all that work requirements do is force people to jump through hoops to prove to bureaucrats what they’re already doing,” the letter stated. “People working multiple jobs or providing care for a loved one don’t have the time or capacity to fill out piles of paperwork, so they will lose their coverage for administrative reasons — not because they don’t qualify for coverage.”
I know this newsletter author, Mariah Thomas, will be following along with the waiver, as will Zöe Buhrmaster, our healthcare reporter here at the Beacon. Stay tuned — and enjoy the rest of Wednesday’s Daily Roundup.
North Valley Food Bank Apple-picking Event Blends Conservation with Community Care
Volunteers will harvest apples from City of Whitefish trees on Sept. 6, helping to eliminate a major food attractant for bears preparing for hibernation
Montana DEQ Denies Petition to Loosen Lake Koocanusa Selenium Standard
The petition from the board of commissioners in Lincoln County is the latest effort to undo safeguards protecting Lake Koocanusa from a mining contaminant called selenium, which is leaching out of B.C. coal mines and into the international watershed
Meet Peggy! She is a sweetheart who loves to play fetch and cannot resist jumping in the water. This pup is about a year old and still learning her leash manners and commands, but will do well with some patience and consistency.
To find out more about Peggy and other pet adoption opportunities at the Humane Society of Northwest Montana go to: www.humanesocietypets.com. To donate to the Humane Society of Northwest Montana, visit the organization’s donation page here.
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