Montana is first to enforce Medicaid work rules, and enrollees say they're confused

Montana began enforcing new Medicaid work requirements on Oct. 1, months before most of the country, and people enrolled in the program say they are struggling to understand what is being asked of them.

Under the new federal rules, adults covered by Medicaid expansion must show they are working, volunteering or studying at least 80 hours a month, or prove they qualify for an exemption such as being "medically frail" or the primary caregiver for a family member. Nearly every state must put the rules in place by Jan. 1. Montana, Nebraska and Arkansas moved early.

In Montana, about 71,000 people are subject to the rules. The state began a soft launch in July and gave enrollees until Oct. 1 to comply.

'Completely confused'

Bethany Zulick of Missoula went back to school in January to become a high school English teacher, working as a substitute by day and taking online classes at night. University health insurance would have cost almost as much as her tuition, so Medicaid made the career change possible.

In June, a letter from the state health department left her "completely confused." It first said she would need to prove compliance at her next renewal next spring. Further down, it said she had to submit paperwork "within 30 days." She wondered whether it was a mass mailing she could ignore, or whether her coverage was on the line.

State Rep. SJ Howell, a Democrat, said dozens of constituents have called about similar letters. "The notices coming from the department are very, very confusing, and it's very hard to find help figuring out what's going on," Howell said. State officials told lawmakers the letters have since been rewritten to be clearer.

Short on staff and help

State health officials say they are prepared and plan to process about 5,000 enrollees a month. But at a Sept. 9 hearing, they told lawmakers that only about 20 of 59 planned positions had been filled, after turnover. A system to automatically confirm college enrollment is not expected until next year, leaving students to track down paperwork themselves.

Outside help has also shrunk. Cover Montana, a nonprofit that helps people fill out these forms, lost its federal funding last year and went from 18 staff to two part-time employees answering a phone line. Federal data show Montanans wait on hold for the state helpline far longer than the national average, and many hang up before reaching anyone.

"We were worried about chaos that could be generated by the state rushing," said Aaron Wernham, CEO of the Montana Healthcare Foundation. "Given how little information the state has provided about what they are doing, I'm much more worried about chaos."

A preview for the nation

Advocates worry that thousands of eligible people could lose coverage simply because they did not understand the rules or could not get the right documents in on time. With most states set to begin in January, health policy experts across the political spectrum are watching Montana closely for lessons, good and bad.

Enrollees who receive a notice should read it carefully, keep copies of pay stubs, school enrollment records or volunteer logs, and contact their state Medicaid office or a local health center for help before any deadline passes.