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In most states, Medicaid recipients will soon have to prove they're working or volunteering or studying in order to stay in the program. That's because of cuts in the Republicans' One Big Beautiful Bill Act. Three states, including Montana, decided to make the change early, and maybe sooner than they were ready. Aaron Bolton of Montana Public Radio begins this story with one person affected.
AARON BOLTON, BYLINE: Bethany Zulick lives in Missoula, Montana. And she's going back to college to become a high school English teacher. Years ago, she taught overseas and loved it.
BETHANY ZULICK: It's so exciting to me to watch someone learn a new word or, you know, have that spark of understanding.
BOLTON: Zulick knew she could pinch enough pennies to make going back to school financially viable, except on health insurance.
ZULICK: The student health insurance would've run me almost as much as my, like, tuition for the semester.
BOLTON: But then she found Medicaid, the government health insurance program for low-income adults. With that coverage, she could make the jump - leave her job and return to school. But this summer, Zulick learned she was one of 71,000 Montanans on Medicaid subject to new work requirements. The state is implementing those rules six months ahead of the federal deadline. At first, Zulick thought the state would automatically renew her coverage because it could see she's enrolled in a state university. But then she got a confusing letter.
ZULICK: Some of the letter says that this information is due at my next recertification and some of it says it's due within 30 days of the letter.
BOLTON: She didn't know what to submit or on what deadline. But what was clear - it wouldn't be submitted or processed automatically. It turns out the state hasn't even set up all the computer systems to do that work, and some won't be ready until next year. Republican state Senate President Matt Regier says having work requirements creates accountability for people relying on the social safety net.
MATT REGIER: And in an economy like this, if you're an able-bodied adult that's able to work, you really do need to step up.
BOLTON: As for the confusion among enrollees, he points out the state is giving people until October 1 to comply before they're kicked off the rolls.
REGIER: Change is always hard, too. That doesn't mean that it's wrong.
BOLTON: There are concerns that the pace at which Montana is moving will result in people unnecessarily losing coverage. Aaron Wernham is the CEO of the Montana Healthcare Foundation. He worries tens of thousands of Montanans could lose coverage, in part because of the computer issue Zulick ran into, but also because as of September, the state has hired only about a third of the staff it says it needs to pull this off.
AARON WERNHAM: We were worried about chaos that could be generated by the state rushing. Given how little information the state has provided about what they're doing, I'm much more worried about chaos.
BOLTON: Health care providers and clinics are also scrambling to understand the rules so they can help patients stay enrolled. State health officials said in a statement that their systems are ready, and said they quote, "are committed to ensuring eligible Montanans maintain coverage." Akeiisa Coleman is with the Commonwealth Fund, a health care research nonprofit. She says Montana and other states starting early are essentially building the plane as they're taking off.
AKEIISA COLEMAN: Montana's going to be an example for what we might see nationally as things roll out.
BOLTON: Coleman says that's because even states that are waiting until the January 1 deadline to start the work requirements probably won't be completely ready either. For NPR News, I'm Aaron Bolton in Columbia Falls, Montana.
INSKEEP: That story comes from NPR's partnership with Montana Public Radio and KFF Health News. Transcript provided by NPR, Copyright NPR.
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