By Katheryn Houghton, KFF Health News
MISSOULA, Mont. — Tywon Pugh has seizures that make it hard to find and keep a job. “They called me a ‘liability to the job site,'” Pugh said, recalling the words of his manager when a seizure led to him losing work in the past. When the 46-year-old lost work before, his wife of 10 years covered their rent. She died, and “my whole base was depleted,” Pugh said.
Medicaid pays for the prescriptions that keep Pugh’s seizures at bay. Now he is worried about keeping that coverage as new federal work requirements take effect. His goal has been to get healthy enough to work again, but staying employed with an unpredictable medical condition has proven difficult.
In the spring, the federal government finalized regulations requiring millions of people who receive Medicaid to prove they are working, volunteering, or in school for a set number of hours each month, or qualify for an exemption. The Trump administration’s rules exempt certain groups, including people with disabilities. But the administration decided that being homeless isn’t on its own a qualifying condition for an exemption — even though advocates and some state officials say the federal exemption list doesn’t match how states have tried to account for homeless enrollees.
Federal officials have said many people who are homeless could fall under another exemption, such as a medical or caregiving exemption, but advocates say the process of proving eligibility is itself a major barrier for people without stable housing, reliable mail, phone service, or transportation.
Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, said the federal rule caught many state officials and advocates off guard. “It took everyone by surprise,” Tolbert said. Mehmet Oz, who leads the Centers for Medicare & Medicaid Services, has touted the work requirements as a “path to prosperity.” In June, 25 mostly Democratic-led states sued the Trump administration over the rules; more than 5 million people nationally are expected to be affected. Most states will begin implementing the work requirements in January; Montana plans to begin removing Medicaid enrollees from coverage this October if they can’t prove they qualify.
Advocates in Montana say the mismatch between paperwork requirements and the realities of homelessness is already straining caseworkers and free clinics. Case managers at homeless shelters and health centers, including Partnership Health Center in Missoula — one of roughly 1,400 federally funded health centers nationwide serving low-income patients — say they are fielding a growing wave of questions from patients confused about whether they will lose coverage.
Pugh has connected with a social worker for help keeping his Medicaid and was waiting to hear whether he’d qualify for a medical exemption. “I just don’t wanna lose hope in the meantime,” he said.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF and KFF Health News.