H.R. 1 Requirements

Montana Draft 1115 Waiver

An enrollee (or applicant) subject to the requirement and not otherwise exempt must demonstrate completion of 80 hours of qualifying activities for at least one month prior to application and, once enrolled, for at least one month within every redetermination period.

�States may require a “look back” period of no more than three months and may require more frequent verifications of compliance.

New applicants: one month “look back” period.

�Current enrollees must show 80 hours in the previous one month. At six-month redetermination, the enrollee must show compliance/exemption for the 30 days prior to the six-month redetermination date.

�At the one-year mark, DPHHS will conduct another “enhanced” redetermination. The enrollee must show compliance/exemption for the 30 days immediately preceding the 12-month mark and show compliance/exemption for at least an additional five months of the 12-month period. 

H.R. 1 Requirements

Montana Draft 1115 Waiver

Completion of at least 80 hours in a given month of:

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• Work;
• Work program (as defined under the SNAP program);
• Community service;
• At least half-time enrollment in education program (college/university, career or technical training); or
• A combination of the above.

Waiver includes H.R. 1 list of qualifying activities.

�Waiver defines work programs to include: work readiness, workforce training activities, internships, and registered apprenticeship.

�Educational programs include: Secondary education, postsecondary education, vocational education, and registered apprenticeships.

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H.R. 1 Requirements

Montana Draft 1115 Waiver

States must provide an exemption for the following individuals for a given month, if any point during that month, they are:

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• Pregnant or accessing postpartum Medicaid coverage;
• Foster youth or former foster youth under the age of 26;
• American Indian or urban Indian, as defined under the Indian Health Care Improvement Act, or otherwise determined eligible for IHS;
• Parent, guardian, caretaker relative, or family caregiver of a dependent child age 13 or under or a disabled individual;
• Veteran with a disability rated as total;

Waiver includes H.R. 1 mandatory exemptions.��

H.R. 1 Requirements

Montana Draft 1115 Waiver

• Medically frail, including an individual who:
• Is Blind or disabled;
• Has a substance use disorder;
• Has a disabling mental disorder;
• Has a physical, intellectual, or developmental disability that significantly impairs their ability to perform 1 or more daily activities of daily living;
• Has a serious/complex medical condition
• Receiving TANF/SNAP benefits and in compliance;
• Participating in a drug addiction or alcoholic treatment and rehab program; or
• Is an inmate or previously incarcerated within a three-month period.

Waiver includes H.R. 1 mandatory exemptions.��

H.R. 1 Requirements

Montana Draft 1115 Waiver

States may also “exempt” from reporting for those who have:

• Wage income of at least 80 hours multiplied by the federal minimum wage ($580 per month); or
• For a seasonal worker, an average monthly income over the past six months of at least $580/month.

An individual with monthly income equal to or greater than $580/month (or seasonal worker with avg monthly income over six months) will be considered compliant and exempt from reporting.

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DPHHS is seeking approval for two additional exemptions, as reflected in Montana law:

• Foster parent of a foster child under the age of 19; and
• An Individual under the supervision of the Department of Corrections, a county jail, or another entity directed by the court.�

H.R. 1 Requirements

Montana Draft 1115 Waiver

States must first use ex parte data “where possible” to verify compliance and exemptions. 

�States can accept self-attestation.

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“To the extent possible,” DPHHS will use information available “in existing systems.” 

�Draft waiver includes several examples, including DLI wage data, SNAP employment data, and medical claims data indicating medical frailty.

�For instances where data is not available, individuals will be required to submit documentation. DPHHS will accept self-reported information online, through a call center, by mail, and in person.

H.R. 1 Requirements

Montana Draft 1115 Waiver

States must contact enrollees by mail, email (if enrollee elects), and at least one other modality about the new requirements.

�Outreach must begin between June 30, 2026, and August 31, 2026, depending on the length of the “look back” period.

�If a state chooses to implement sooner, the state must conduct at least three months of outreach plus the “look back” period prior to implementing.

�DPHHS will provide notice to enrollees during the application and redetermination process.

�No mention of timeline for outreach.

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H.R. 1 Requirements

Montana Draft 1115 Waiver

Failure to report compliance or determined exempt will result in:

• Denial of coverage, for a new applicant;
• Termination of coverage, for a current enrollee.

�States must provide written notice of noncompliance and provide 30 days (from the date of receiving notice) to come into compliance or demonstrate an exemption.

�An individual who is found out of compliance will also be barred from accessing Marketplace insurance subsidies/credits.

Waiver includes the same compliance language.�

H.R. 1 Requirements

Montana Draft 1115 Waiver

States must impose cost sharing for certain services provided to expansion adults with income above 100% FPL.

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Effective October 1, 2028.

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Exemptions – prenatal, family planning, certain emergency services, primary care services, mental health services, SUD, services provided by rural health clinic, FQHC, CCBBHC

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Montana law prohibits imposing copays.

�DPHHS intends to implement copays effective October 1, 2028.

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H.R. 1 Requirements

Montana Draft 1115 Waiver

States are prohibited from imposing an enrollment fee or premiums on those subject to cost sharing.

Montana is seeking approval to implement monthly premiums on all expansion enrollees, 2% of income, increasing based on the length of time enrollees in Medicaid.

�Montana seeks approval to maintain premium requirements past Oct. 1, 2028, which would be imposed in addition to required copays.

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Exemptions?