Montana’s Medicaid plan pushes caregivers off a cliff

As a home care worker, I help seniors and people with disabilities live safely and independently in their homes. I love my job — but it’s not easy. The hours can be unpredictable. The pay is low.

That’s why I’m deeply concerned about the new Medicaid changes that Speaker Sen. Matt Regier praised in his recent op-ed in this newspaper. 

The overwhelming effect of these changes will be to strip health coverage from people who are already doing their best. They would create reporting requirements and monthly premiums for Medicaid recipients, the vast majority of whom–like me–work hard to make ends meet. 

Let me be clear: I already work and my salary depends on Medicaid. Most people I know on Medicaid are working, going to school, caring for kids or aging parents, or managing health issues. According to the Kaiser Family Foundation, 92% of non-disabled adults on Medicaid already meet federal work or exemption criteria.

The leaders of the legislature and state government are pushing a recipe for people to fall through the cracks. Under Montana’s own proposal, more than 7,500 people could lose Medicaid coverage by 2026. By 2030, nearly 1 in 5 Medicaid recipients could be cut off.

Not because they don’t want to work — but because of paperwork problems, missed deadlines, or shifting schedules. When you’re a caregiver like me, one week of fewer hours could jeopardize your coverage. When you’re juggling multiple jobs, childcare, or spotty internet, filing government forms out every six months is a lot harder than it sounds.

The state is also proposing monthly premiums, even though federal law will prohibit them starting in 2028. These premiums — based on income and time enrolled — might seem small, but for people living paycheck to paycheck, they’re a serious burden. And if you can’t pay? You could lose your coverage altogether.

Montana doesn’t need to rush into this. The federal law gives states until the end of 2026 to implement work rules. Guidance from the federal government is still months away. But our state is plowing ahead anyway — without waiting for clearer direction, and without fully addressing the systems that already caused thousands of people to lose coverage during redeterminations last year.

I’ve been proud to speak up on health care policy in Montana before, because I know what’s at stake. When policymakers talk about “accountability,” they need to hold themselves accountable to the caregivers, grocery clerks, restaurant workers, and parents who are already carrying so much.

We don’t need more barriers — we need a system that works for the people who work for Montana.

Celeste Thompson is a home caregiver in Missoula.