Bethany Zulick went back to school in January to become a high school English teacher. Years ago, she taught English as a second language overseas and loved it. "It's so exciting to me to watch someone learn a new word or have that spark of understanding," said Zulick, who lives in Missoula.
This story was produced in partnership with KFF Health News. Zulick knew she could earn enough money as a substitute teacher to make going back to school financially viable — except for the cost of health insurance. She didn't want to risk being unable to see her doctor for her allergies or for preventive care.
The health insurance offered through Montana State University was too expensive, Zulick said, almost as much as her tuition. But then she found a solution that allowed her to make the leap: Medicaid. She wouldn't have to pay any monthly premiums.
It worked well for a few months, as Zulick taught by day and took online classes at night. But in June, the state sent a letter that she said left her "completely confused." She knew Montana was rolling out a system for Medicaid work requirements over the summer, but she thought she wouldn't have to prove she met the requirements until next year, when her Medicaid enrollment came up for renewal. Yet the letter from the Montana Department of Public Health and Human Services outlining the new requirements gave conflicting information on when Zulick would have to prove she was meeting them.
First, it said at her next renewal, which would be sometime next spring. Lower down, it told her she would have to submit paperwork to prove compliance much earlier — "within 30 days" of the date on the letter, June 26. She wondered: Was it a boilerplate mass-mailing letter she could ignore, or was her insurance on the line?
All states must implement the new work requirements by Jan. 1, but three states — Montana, Nebraska and Arkansas — have already gotten started. Medicaid advocates worry that the expedited timeline in those states will lead to thousands of people losing coverage because they're confused about the new rules, even if they are eligible for the program — and that Montana may offer a troubling preview of what will happen nationwide next year. State health department officials maintain they are well prepared and told state lawmakers they plan to process roughly 5,000 enrollees monthly.
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