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Montana officials outline HR 1 Medicaid rollout; recipients and advocates urge delay
Summary
DPHHS presented operational plans to implement HR 1 changes for Medicaid expansion — an 80‑hour monthly community‑engagement standard and six‑month redeterminations starting in 2027 — while lawmakers and clients warned the department to pause implementation and improve outreach to avoid unintended coverage losses.
The Montana Department of Public Health and Human Services on Thursday detailed how it will implement federal HR 1 changes affecting Medicaid expansion adults, describing new documentation, verification and redetermination processes while acknowledging outstanding federal guidance and wide public concerns.
DPHHS Director Charlie Brereton opened the committee briefing by saying the department will advance a package of agency proposals for the 2027 legislative session but that "all of those proposals are still subject to governor's office review and approval." He invited agency leaders to describe implementation steps.
Rebecca Decamara, Montana's Medicaid director, gave a high‑level refresher on HR 1 — the House Reconciliation Bill — and its impacts on eligibility and enrollment rules. Human‑Services Executive Director Jesse Counts walked the committee through how the state plans to operationalize the new community‑engagement requirement for Medicaid expansion participants.
Counts told lawmakers that the department will require non‑excluded expansion adults to document qualifying activities that together meet an 80‑hour threshold in a calendar month. "Clients will need to spend at least 80 hours completing qualifying activities during each month that they need to report to us," he said, describing acceptable evidence such as pay stubs, signed volunteer logs and program participation letters.
DPHHS said some verifications can be handled through data matching — for example, wage records from the Department of Labor and Industry — and that an income threshold based on federal minimum wage (roughly $580 per month at $7.25 × 80 hours) will be treated as proof of compliance in some cases. The department plans to use ex parte (auto‑renewal) where available and will send a 30‑day notice for redeterminations when verification is incomplete.
Counts also outlined exclusions that will exempt some adults from community‑engagement rules, including former foster youth under 26, caregivers of young children or persons with disabilities and several short‑term hardship categories. He said American Indians and Alaska Natives will remain on a 12‑month redetermination cycle. On the definition of "medically frail," Counts said the department is still developing criteria and awaiting CMS guidance.
The department described timing adjustments tied to federal implementation: retroactive coverage for expansion adults will shrink from three months to one month effective Jan. 1, 2027, and changes to noncitizen funding will take effect Oct. 1, 2026. Divisional leaders emphasized outreach plans: universal notices were mailed in March, targeted notices will be sent months ahead of individual redeterminations, and the agency plans a community‑assister portal and forms to help clients document activities and exclusions.
Lawmakers pressed the agency on readiness. Vice Chair Representative Tom Howe asked about the state plan amendment (SPA) timeline; Jesse Counts said DPHHS aims to file the SPA by the end of May. Several legislators and members of the public urged a slower rollout given unresolved rule language, outstanding CMS guidance and recent administrative problems with notices and renewals.
Public commenters and advocacy groups made the timing issue central. Dandelion Cloverdale, a Missoula Medicaid enrollee, said a recent notice she received left her "uneasy" and urged the committee to "allow more time before implementation." Another enrollee, Keegan Nashan, said they had not received departmental notices in the online portal and warned that hurried implementation could lead to avoidable coverage loss.
Agency officials urged recipients and community partners to use medicaidchanges.mt.gov for up‑to‑date guidance and said they will expand webinars, community outreach and training for community assisters.
What's next: DPHHS told the committee it will continue stakeholder outreach, file the state plan amendment by the end of May, and expects to present additional implementation detail and rules in July. The department said it will use multiple attempts to reach affected clients and that those who believe an adverse action is incorrect retain the right to a fair hearing under existing processes.
