This web page was created programmatically, to learn the article in its authentic location you may go to the hyperlink bellow:
https://www.npr.org/2026/08/04/nx-s1-5918346/medicaid-work-requirement-montana-homeless
and if you wish to take away this text from our website please contact us
Izzy Kadrmas, a medical assistant at Partnership Health Center’s Watershed Clinic in Missoula, Montana, prepares to take Tywon Pugh’s blood for testing.
Katheryn Houghton/KFF Health News
cover caption
toggle caption
Katheryn Houghton/KFF Health News
MISSOULA, Mont. — Tywon Pugh has seizures that make it arduous to search out and hold a job.
“They called me a ‘liability to the job site,'” Pugh stated, recalling the phrases of his supervisor when a seizure price him his final job at a fast-food restaurant on this western Montana metropolis.
When the 46-year-old misplaced work up to now, his spouse of 10 years coated their lease and he tended to their dwelling till he discovered one other job. But his spouse died final yr. Soon after, Pugh grew to become homeless. His downside with alcohol grew to become worse, which made managing his seizures harder.
For the newest tales on the science of wholesome residing, subscribe to NPR’s Health publication.
“When she died, my whole base was depleted,” Pugh stated.
Medicaid pays for the prescriptions that hold Pugh’s seizures at bay. The government-subsidized well being protection would additionally pay for an habit remedy program that Pugh says he has tried to get into, however he was advised there is a waitlist.
Pugh’s aim has been to get wholesome sufficient to work once more. But he is fearful about having the ability to hold the Medicaid protection he must get to that time.
Early embrace of latest guidelines
In the spring, the federal authorities finalized rules requiring hundreds of thousands of people that obtain Medicaid advantages to show they’re working, volunteering, or going to highschool to maintain their protection. States have till January to start these checks. Montana, Arkansas, and Nebraska have already began implementing them.
The Trump administration’s federal work necessities exempt sure teams of individuals: these with disabilities, these older than 64, pregnant individuals and Native Americans, amongst others. To obtain an exemption, anybody and not using a clear-cut qualification — akin to by means of their age or incapacity standing — must show they’re too sick to work.
But the administration determined that being homeless is not a medical situation and might’t rely as an computerized out from having to satisfy the brand new necessities. Many conservative policymakers help work necessities, and a few states have tried to implement such guidelines for years. At least 4 states — Montana, Arizona, Kentucky and Utah — beforehand proposed insurance policies that included homelessness as an exemption.
But federal officers have stated that is not allowed. In an e mail to KFF Health News, the Centers for Medicare & Medicaid Services declined to offer a touch upon the file. But the company confirmed that states should keep on with the federal authorities’s listing of exemptions. Homelessness within the U.S. has elevated by 27% from 2013 to 2025, according to data from the Department of Housing and Urban Development. Last yr, about 746,000 individuals were homeless.
Many, like Pugh, certified for Medicaid, although the variety of enrollees who’re homeless is troublesome to measure. In 2023, 55% of patients who obtained medical or behavioral well being providers by means of one of many nation’s roughly 300 Health Care for the Homeless applications had been enrolled in Medicaid.
Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, stated the federal rules are rather a lot stricter than many states had anticipated, even these on board with work necessities. (KFF is a well being info nonprofit that features KFF Health News.)
“It took everyone by surprise,” Tolbert stated.
Mehmet Oz, who leads CMS, touted the rules as a “path to prosperity” throughout a press convention in June.
“We need to get people to try to work,” Oz stated. In June, 25 principally Democratic-led states sued the Trump administration over the rules, arguing the medical frailty customary can be too arduous for enrollees to satisfy — and for states to evaluate. The work necessities are projected to extend the variety of uninsured individuals nationwide by more than 5 million by 2034, in response to the Congressional Budget Office.
Most states will start to implement the Medicaid work necessities in January 2027.
Montana plans to start booting Medicaid enrollees from protection in October 2026 if they can not show they’re in compliance with the work requirement.
“My Medicaid is still active, but when are they gonna cut that off from me?” Pugh stated. “I can’t get employed. How am I supposed to survive?”
The variations between the states’ and federal authorities’s exemption lists do not finish with people who find themselves homeless. In Montana, lawmakers additionally deliberate to excuse individuals fleeing home violence and caregivers of hospitalized relations — two different teams left off the federal exemption listing.
“These are simply parties that, due to a number of conditions, cannot meet those requirements,” Republican state Rep. Ed Buttrey stated in 2019 when the Montana Legislature handed its first Medicaid work requirement invoice. Buttrey didn’t remark for this text.
Federal officers have stated many people who find themselves homeless may fall below one other exemption, akin to being too sick to work. But, like many states, Montana’s system to routinely conduct these checks by means of current medical data is not prepared, although well being division spokesperson Jon Ebelt stated it ought to be in place by October. Anyone not routinely exempted by the state would have 30 days to show their case.
A doable exemption for well being
Pugh may qualify for a go on account of his seizures. But attending to physician appointments the previous yr has been arduous for him.
The anniversary of his spouse’s dying simply handed. Typically, Pugh has to discover a new place to sleep outdoors every night time. One night time whereas tenting, Pugh misplaced his pockets and necessary paperwork. And with the habit remedy facilities that settle for Medicaid sufferers overbooked, Pugh has needed to depend on willpower to keep away from ingesting.
“I’m taking it one day at a time,” he stated.
A little bit over two hours north, in Kalispell, Dustin Goss, a case supervisor at a homeless shelter referred to as Samaritan House, stated Pugh’s expertise displays why he is fearful that individuals who qualify for an exemption will get tangled in bureaucratic tape.
“You can’t really worry about getting paperwork done when you don’t know where you’re eating today,” Goss stated.
Cassidy Kipp, who heads Samaritan House, stated as soon as individuals discover shelter and begin to stabilize, they usually discover work. But even then, assembly the brand new necessities could be difficult. Clients typically begin with short-term and casual jobs — akin to cleansing out a storage unit — that do not include a pay stub, Kipp stated.
Kaitlyn Bosshardt, a social employee at Partnership Health Center, a well being clinic in Missoula, has seen extra individuals priced out of longtime leases as housing prices outpace individuals’s paychecks. Meanwhile, inexpensive housing and rental assist are restricted.
Partnership Health is one among roughly 1,400 well being facilities nationwide that obtain federal funding to serve sufferers primarily based on what they’ll afford — which means even those that lose Medicaid can obtain care. But organizations representing well being facilities have stated if too many sufferers lose the protection, some clinics will not have the ability to fill the monetary gap.
The different downside is that these clinics usually do not present specialty care.
One day in June, as temperatures hovered round 90, Pugh visited Watershed Navigation Center, a refuge run by Partnership for individuals with out regular housing to have a meal or see a physician. His physician, Atarah Sidey, advised Pugh that the neurology clinic that managed his seizures had dismissed him from their care after he missed three appointments.
She referred Pugh to the opposite neurologist on the town and talked about looking for remedy for his habit.
“It’s just that if I don’t make the effort at changing, it ain’t gonna happen and I’m gonna end up found on the side of the road somewhere,” Pugh advised Sidey.
“You got this, though, Tywon,” she responded as Pugh nodded his head. “You can do this.”
Pugh has related with a social employee for assist protecting his Medicaid. By late July, he was ready for house to open at a Missoula habit remedy middle and ready on responses from two job functions.
In the arduous moments, Pugh imagines his spouse telling him to remain calm, that issues will get higher.
“I just don’t wanna lose hope in the meantime,” he stated.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.
This web page was created programmatically, to learn the article in its authentic location you may go to the hyperlink bellow:
https://www.npr.org/2026/08/04/nx-s1-5918346/medicaid-work-requirement-montana-homeless
and if you wish to take away this text from our website please contact us
