County officials warn HR1 Medicaid changes will strain safety net; symposium planned

County health officials told the council that federal HR1 policy changes will significantly alter Medicaid rules and that the county is preparing to respond.

"Those changes will take effect as of 01/01/2027," a county official said, summarizing two key timelines: work requirements (an 80‑hours‑per‑month threshold) and six‑month eligibility redeterminations. Officials said an October 1 change will make most asylees and refugees ineligible for Medicaid (pregnant women and children remain eligible), and they estimated the affected asylee/refugee population at roughly 2,000–3,000 locally (a county estimate). County staff emphasized that the state is providing toolkits and that local partners will need training to implement outreach and re‑enrollment support.

To prepare, the county will convene a Medicaid symposium in August 2026 for community nonprofits and partners to train trainers on state toolkits, and staff are working with WorkSource Montgomery to expand volunteer and employment verification supports. The briefing flagged operational shortfalls: a previous budget proposal for seven additional eligibility workers did not pass, and staff said processing workloads effectively double under six‑month redeterminations. "We still think that that [7 eligibility workers] would be helpful," a health official said, noting the county must decide whether to expand Montgomery Cares budgets, institute waitlists, or otherwise prioritize services if demand increases.