Montana expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 70,456 of them (10.9% of an expansion pool of 75,318) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.
This model's bottom-up estimate is that 31,982 people in Montana lose coverage by 2034: 29,868 of them still eligible but lost to paperwork and reporting failures, and 2,114 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.
Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Montana scores 54 of 100 on this model's ex parte capability index, a mid band; its eligibility system is CHIMES.
Key figures
| Measure | Montana |
|---|---|
| Expansion state | Yes |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 75,318 |
| Adults subject, strict definition | 70,456 |
| Adults subject, permissive definition | 69,046 |
| Share of expansion pool subject | 10.9% |
| Projected coverage loss by 2034 | 31,982 |
| Hardship exception status | Adopting |
| Early implementer | 2026-07-01 |
| Ex parte capability score (0 to 100) | 54 (mid) |
Who is subject in Montana
Of the 70,455 subject adults, 44% already work 80 or more hours a month and 48% are not working. 34% have a child under 14 at home. Among those not working, 51% report a disability and 18% are caregivers.
| Characteristic | Share of subject adults |
|---|---|
| Age 19-24 | 17% |
| Age 25-34 | 23% |
| Age 35-44 | 21% |
| Age 45-54 | 17% |
| Age 55-64 | 23% |
| Not working | 48% |
| 1 to 19 hours a month | 1% |
| 20 to 79 hours a month | 7% |
| 80 or more hours a month (meets the bar) | 44% |
| Not working: Disabled | 51% |
| Not working: Caregiver | 18% |
| Not working: Postpartum | 0% |
| Not working: Student | 1% |
| Not working: Other | 30% |
Why eligible people lose coverage
Of the 31,982 projected to lose coverage in Montana, 29,868 meet the requirement or qualify for an exemption but fail to document it. 8,387 of those are working people who cannot prove their hours through data the state can see, and 21,481 qualify for an exemption the state does not detect automatically.
| Group | Projected to lose coverage |
|---|---|
| Multiple part-time jobs (aggregation failure) | 2,712 |
| Self-employed (other) | 1,760 |
| Variable shifts / on-call work | 1,554 |
| Cash-paid construction & trades | 684 |
| Seasonal: agriculture, hospitality, food service | 586 |
| Full-time students not auto-verified | 479 |
| Volunteering / job training | 429 |
| Gig / courier (DoorDash, Uber, Lyft, Instacart) | 183 |
| Medically frail without auto-match | 7,348 |
| American Indian / Alaska Native (tribal exemption) | 4,167 |
| Parent caregivers of children ≤13 without auto-match | 3,231 |
| Caregivers of a disabled adult | 3,055 |
| SUD treatment not flagged in claims data | 1,589 |
| Kinship caregivers (non-parent) of children ≤13 | 1,006 |
| Recent incarceration (data-match gap) | 687 |
| Other categorical exemptions (foster, AYA cancer, SNAP/TANF) | 364 |
| Pregnancy / postpartum data lag | 34 |
Can the state renew people automatically?
The ex parte capability index blends the state's observed automatic-renewal rate (55% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Montana's composite score is 54 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.
| Component | Score |
|---|---|
| Composite | 54 |
| Observed ex parte | 55 |
| Core capability | 47 |
| Data sources | 55 |
| Historical churn | 50 |
How subjects overlap across exemption categories
| Combination | Adults | Share |
|---|---|---|
| None of the four | 22,323 | 31.7% |
| Working ≥ qualifying hours / income | 15,435 | 21.9% |
| Medically frail | 10,947 | 15.5% |
| Working ≥ qualifying hours / income + Parent caregiver of child ≤13 | 10,191 | 14.5% |
| Parent caregiver of child ≤13 | 4,091 | 5.8% |
| Working ≥ qualifying hours / income + Full-time student | 2,167 | 3.1% |
| Working ≥ qualifying hours / income + Medically frail | 1,726 | 2.5% |
| Full-time student | 944 | 1.3% |
Counties in Montana
Subject adults concentrate: Yellowstone County (9,837), Gallatin County (8,502), and Missoula County (7,582) account for 37% of the state's subject population.
| County | Adults subject | Subject rate | Projected loss | Poverty rate | Working-age population |
|---|---|---|---|---|---|
| Yellowstone County | 9,837 | 10.1% | 4,466 | 11.0% | 97,440 |
| Gallatin County | 8,502 | 10.4% | 3,859 | 11.0% | 81,485 |
| Missoula County | 7,582 | 9.9% | 3,442 | 12.0% | 76,244 |
| Flathead County | 6,683 | 10.7% | 3,034 | 9.0% | 62,366 |
| Cascade County | 4,975 | 10.3% | 2,258 | 14.0% | 48,308 |
| Lewis and Clark County | 4,343 | 10.3% | 1,972 | 9.0% | 42,231 |
| Ravalli County | 3,158 | 12.6% | 1,433 | 10.0% | 24,990 |
| Silver Bow County | 2,303 | 10.9% | 1,046 | 16.0% | 21,076 |
| Lake County | 2,166 | 12.6% | 983 | 19.0% | 17,222 |
| Lincoln County | 1,502 | 13.9% | 682 | 17.0% | 10,838 |
| Park County | 1,111 | 10.9% | 504 | 11.0% | 10,216 |
| Sanders County | 1,064 | 16.6% | 483 | 16.0% | 6,398 |
| Hill County | 1,001 | 11.5% | 454 | 17.0% | 8,700 |
| Jefferson County | 823 | 11.5% | 374 | 5.0% | 7,154 |
| Big Horn County | 798 | 11.7% | 362 | 26.0% | 6,838 |
| Carbon County | 777 | 13.0% | 353 | 10.0% | 5,982 |
| Fergus County | 746 | 12.0% | 339 | 15.0% | 6,234 |
| Custer County | 743 | 10.7% | 337 | 11.0% | 6,972 |
| Glacier County | 730 | 9.7% | 331 | 29.0% | 7,518 |
| Richland County | 709 | 11.3% | 322 | 8.0% | 6,303 |
| Beaverhead County | 677 | 12.2% | 307 | 15.0% | 5,560 |
| Madison County | 659 | 13.9% | 299 | 7.0% | 4,744 |
| Deer Lodge County | 639 | 10.9% | 290 | 23.0% | 5,859 |
| Stillwater County | 636 | 13.1% | 289 | 8.0% | 4,850 |
| Roosevelt County | 626 | 11.2% | 284 | 32.0% | 5,584 |
| Dawson County | 579 | 11.6% | 263 | 7.0% | 5,000 |
| Broadwater County | 524 | 12.4% | 238 | 9.0% | 4,242 |
| Rosebud County | 485 | 11.2% | 220 | 20.0% | 4,323 |
| Valley County | 460 | 11.8% | 209 | 12.0% | 3,896 |
| Teton County | 403 | 12.4% | 183 | 14.0% | 3,244 |
| Pondera County | 392 | 12.2% | 178 | 22.0% | 3,210 |
| Blaine County | 382 | 10.3% | 173 | 20.0% | 3,690 |
| Powell County | 379 | 8.3% | 172 | 5.0% | 4,588 |
| Chouteau County | 375 | 11.9% | 170 | 15.0% | 3,160 |
| Musselshell County | 366 | 14.1% | 166 | 12.0% | 2,590 |
| Mineral County | 337 | 13.5% | 153 | 14.0% | 2,497 |
| Phillips County | 313 | 14.1% | 142 | 7.0% | 2,212 |
| Toole County | 313 | 10.3% | 142 | 11.0% | 3,047 |
| Sweet Grass County | 254 | 13.0% | 115 | 6.0% | 1,958 |
| Sheridan County | 249 | 12.4% | 113 | 10.0% | 2,000 |
| Granite County | 232 | 12.7% | 105 | 13.0% | 1,830 |
| Fallon County | 202 | 13.6% | 92 | 13.0% | 1,489 |
| Meagher County | 166 | 15.9% | 75 | 12.0% | 1,046 |
| Judith Basin County | 159 | 15.3% | 72 | 18.0% | 1,038 |
| Wheatland County | 145 | 14.5% | 66 | 23.0% | 1,002 |
| McCone County | 138 | 16.4% | 63 | 2.0% | 844 |
| Powder River County | 127 | 14.2% | 58 | 13.0% | 898 |
| Daniels County | 116 | 15.7% | 52 | 12.0% | 736 |
| Carter County | 99 | 15.1% | 45 | 17.0% | 652 |
| Liberty County | 97 | 9.9% | 44 | 26.0% | 987 |
| Prairie County | 96 | 19.2% | 44 | 22.0% | 499 |
| Golden Valley County | 65 | 14.2% | 29 | 16.0% | 454 |
| Garfield County | 64 | 12.1% | 29 | 9.0% | 527 |
| Wibaux County | 63 | 10.8% | 28 | 18.0% | 580 |
| Treasure County | 49 | 11.3% | 22 | 10.0% | 432 |
| Petroleum County | 36 | 14.1% | 16 | 6.0% | 255 |
State brief and methodology
Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.