LULU GARCIA-NAVARRO, HOST:
Making people verify their job status before getting Medicaid has been a hot idea among Republicans since President Trump took office. But after a federal judge blocked some states from doing it, there's been a chilling effect. But Montana is sticking with its plan, which starts in January. Corin Cates-Carney of Montana Public Radio says that's causing worry for residents who work rural or seasonal jobs.
CORIN CATES-CARNEY, BYLINE: Helmville, Mont., has a saloon, two churches, a school that goes through eighth grade and a post office and lots of sweeping ranchland surrounded by mountains.
(SOUNDBITE OF COWS MOOING)
CATES-CARNEY: Twenty-eight year old Kate Clyatt works here as a ranch hand. It's time to move cattle, so she coils up an electric fence on a spool and whistles to encourage the herd to move through.
KATE CLYATT: (Whistling).
CATES-CARNEY: Clyatt is wearing a pearl snap-collared plaid tucked into blue jeans, and a sweat-stained cap keeps the sun from her eyes. She's got a brace on her right wrist, a recent injury from rolling a four-wheeler. When she could no longer receive health insurance under her parents' coverage, she signed up for Montana's Medicaid expansion program.
CLYATT: Ranching is just not a job that has a lot of money in it, right? And so I don't know at what point I'm going to be able to get off of Medicaid.
CATES-CARNEY: Clyatt says it's a hard way to make a living, but she loves working outside. Clyatt doesn't keep track of her hours. She gets paid by the month. And she's unclear how that might fit into Montana's new law. It says certain people on Medicaid need to work or be in school, rehab or other service activities for at least 80 hours a month.
CLYATT: There's a lot of seasonal work in our parks, in our forest systems, in guiding, bringing income into the state. I mean, there's just a lot of seasonality to a lot of kind of the quintessentially Montana jobs.
CATES-CARNEY: The new law tries to take seasonal workers into account, but the state still hasn't worked out all the details. The work requirement starts in January. For rural workers like Clyatt, the reporting process could be difficult. She says she only gets cell service at the stop sign on the edge of town. When Arkansas put in place similar work requirements, 18,000 people lost coverage.
Heather O'Loughlin is with the Montana Budget and Policy Center, an organization that advocates for people on low incomes.
HEATHER O'LOUGHLIN: It's important to note that we could see a loss of coverage of those that are currently enrolled accessing health care coverages.
CATES-CARNEY: State health officials estimate up to 12,000 people could lose health coverage in Montana. The policy passed the Montana Legislature with unanimous support from Democrats and was signed by Governor Steve Bullock. He's based his presidential run on his track record of political wins in a conservative-leaning state.
This new law was a political compromise. The Medicaid expansion was going to expire this summer, but Republicans refused to renew it without a work requirement. Republican State Representative Ed Buttrey carried the bill. He expects some people will lose coverage but says the requirements are not meant to be punitive.
ED BUTTREY: We never set a number of people to try to purposely disenroll. We wanted to find out how many folks were truly able-bodied and non-working that should be doing more to benefit themselves and their family but weren't.
CATES-CARNEY: There's still one more step. Montana needs federal approval for the work requirement and might not get an answer for months. Almost 9% of Montanans are on Medicaid. And just like in other states, most of them are already working.
For NPR News, I'm Corin Cates-Carney in Helena.
GARCIA-NAVARRO: This story came to us from NPR's reporting partnership with Montana Public Radio and Kaiser Health News.