Taya Hailstone has been free from Hodgkin lymphoma for five years. However, the disease has left her with lasting effects on her organs and nerves, making simple tasks difficult. Despite these challenges, Montana’s health department has determined she is no longer eligible for Medicaid’s low-cost disability health coverage.
The switch to the state’s Children’s Health Insurance Program happened just before she aged out. The decision was made without consulting her medical team, according to letters from her doctors reviewed by KFF Health News. It followed her cessation of Social Security disability payments, a move Hailstone made with hopes of improving her health enough to work.
“It feels like this process was made to make you give up,” Hailstone said.
Individuals with disabilities often face hurdles getting federally subsidized health coverage due to their illness. New federal Medicaid work requirements mean states must now determine who qualifies for medical exemption, reviewing more cases.
Many specialists assert that states are ill-prepared to decide exemptions under these requirements, which may lead to more denied coverage. Families USA, a national nonprofit, predicts that millions will face similar challenges.
In Montana, an estimated 18.5 million people must meet new federal requirements, proving they’re engaged in work, education, or volunteering to retain their Medicaid coverage. However, some exceptions are allowed for those unable to work due to health conditions.
New federal guidelines have made these exemptions more complex. The Congressional Budget Office expects over 5 million people to lose Medicaid coverage by 2034 due to work requirements.
Many Republican policymakers and the Trump administration have supported Medicaid work requirements to save resources for the most needy. These requirements were formalized through last year’s One Big Beautiful Bill Act. States have until January 2027 to implement these rules, with some starting checks early.
In June, 25 states challenged the medical frailty rules, claiming they are too difficult for patients and states to evaluate. The lawsuit is still pending.
Hailstone’s cancer battle began at age 10, with complications leading to part of her intestines being removed. This left her with issues like dehydration and swelling that affect her ability to function daily. Despite being in remission, she still suffers from mental and physical effects.
Living with her mom in Roundup, Montana, Hailstone drives nearly two hours regularly for specialized medical care. Her appointments include seeing therapists and counselors.
Taya’s mother, Kyla Hailstone, claims the state’s process for determining her daughter’s disability status is unclear and slow. Reapplying for Social Security payments could guarantee Medicaid but would limit work opportunities.
The Montana Legal Services Association indicates state officials can independently review medical records, but gaps remain in the system. Some decisions depend on state capacity and can leave people without coverage.
Pamela Herd, a University of Michigan professor, observes that public systems often require legal consultation, which complicates access to benefits. This has potential implications for future needs.
Montana officials have pledged to automatically review medical records to assist qualification for exemptions but acknowledge additional steps may still be necessary.
Doctors anticipate increased responsibility in judging illness qualifications for work exemptions, adding pressure to an already burdened system. Montana’s grace period ends in October, leaving room for potential clarity in the process.
Organizations like KFF Health News remain dedicated to providing comprehensive health journalism, shedding light on these evolving issues.