Montana Medicaid coverage ends for many reasons in 2026: a renewal form that never reached the state, income that rose above 138% of the Federal Poverty Level, a move, a change in household size, or a failure to confirm information the Department of Public Health and Human Services (DPHHS) requested. Whatever the reason, the loss itself is a qualifying life event, and it opens a Marketplace Special Enrollment Period (SEP). Montana does not run its own exchange, so you enroll through healthcare.gov. The federal site says people who lost Medicaid or CHIP coverage in the past 90 days can qualify for an SEP, and you may be able to apply shortly before your Medicaid ends. That 90-day window is longer than the standard 60-day window that applies to most job-based coverage losses, so read the end date on your DPHHS notice first, then count forward. Montana Medicaid is also open year-round, which means a termination for paperwork reasons can often be fixed by re-applying or supplying the missing documents. Do both in parallel: ask DPHHS to reconsider while you price a backup Marketplace plan, because the 90-day clock on the Marketplace keeps running while you wait for the state.
Federal H.R. 1 rules are changing who keeps Medicaid expansion coverage in Montana. The federal law requires states to apply work and community engagement requirements to expansion adults and to move to six-month eligibility renewals, with a federal deadline of January 1, 2027. Montana DPHHS announced it intended to start earlier, with a target of July 1, 2026, but the exact date, the exemption rules, and when non-compliance leads to disenrollment have shifted during 2026, so verify the current status at dphhs.mt.gov before relying on any single date. For you, the practical lesson is simple: keep your mailing address current with DPHHS, open every envelope from the state, and respond within the days listed on each notice. If you lose coverage because of a missed work-reporting or renewal step, the loss still qualifies you for the Marketplace SEP in most cases, and you may be able to cure the problem and regain Medicaid. Compare both paths now rather than after the 90 days run out. Montana's roughly 74,000 expansion adults (73,895 as of March 2026 per the Legislative Fiscal Division) are the group most exposed to these 2026 and 2027 changes.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The costliest mistakes Montanans make after losing Medicaid in 2026:
- Waiting until the last week of the 90-day window. Marketplace plans bought late start the next month, so apply within two weeks of the notice date.
- Skipping the Medicaid re-application. Montana Medicaid is free and year-round, and many terminations for missing paperwork can be reversed with the right documents.
- Reporting last year's income to healthcare.gov. Use your projected 2026 income, or your credits and your 1095-A reconciliation will not match.
- Dropping children from coverage. Children can stay eligible for Healthy Montana Kids up to 261% FPL even when a parent no longer qualifies for Medicaid.
- Ignoring mail from DPHHS. Missed notices about renewals or work reporting are a leading reason for Montana Medicaid terminations in 2026.
Montana Medicaid vs Marketplace vs Healthy Montana Kids: Which Path Fits in 2026?
Montana Medicaid (the HELP program) is the first stop for any Montana adult whose projected 2026 income is at or below 138% FPL, which is $22,025 for one person or $45,540 for a family of 4 per HHS ASPE 2026 Poverty Guidelines. Medicaid costs nothing for most services and accepts applications at apply.mt.gov all year. Healthy Montana Kids (HMK) covers children up to 261% FPL in 2026, roughly $86,100 a year for a family of 4 (the DPHHS table lists $7,178 per month), so children often stay covered while parents move to a Marketplace plan. Marketplace plans through healthcare.gov fit adults above 138% FPL, and premium tax credits cut the monthly price for incomes up to 400% FPL ($63,840 single, 2026). Households above that line pay full price because the subsidy cliff returned in 2026. Apply to Medicaid first, check each child for HMK, then price Marketplace plans for the remaining adults.
Montana Medicaid Work Requirements and Six-Month Renewals After H.R. 1
Federal H.R. 1 requires states to apply community engagement requirements to Medicaid expansion adults by January 1, 2027, typically 80 hours a month of work, school, training, or service, with exemptions for medical frailty, caregiving, and pregnancy. The law also moves expansion adults to eligibility renewals every six months. Montana DPHHS signaled an earlier start, with July 1, 2026 as its target, and described a period when enrollees would receive warnings before disenrollment began. Rules, dates, and exemption definitions have been changing, so confirm the current schedule at dphhs.mt.gov and with the Montana Public Assistance Helpline at 1-888-706-1535. Losing Medicaid under these rules still counts as losing coverage for the Marketplace SEP in most cases, but a reversible paperwork problem is worth fixing quickly because re-enrollment is free. Keep proof of hours, school enrollment, or exemption status in one folder.
Documents That Prove Your Montana Medicaid Loss and Your 2026 Income
DPHHS termination notices are the primary proof that you lost coverage, and healthcare.gov may ask you to upload that letter to confirm the Special Enrollment Period. Pay stubs and an employer letter prove the income that decides your premium tax credit, and the Marketplace compares your figures with IRS and Social Security records. Identity and immigration documents confirm who is applying. Each document answers a specific verification question, so a missing page is the most common reason an SEP application stalls. Upload clear photos before you call the Marketplace Call Center, and keep copies for the year-end reconciliation with Form 1095-A. If your notice never arrived, log in to your apply.mt.gov account or call 1-888-706-1535 for a replacement showing the end date and the reason.
Frequently Asked Questions
How long do I have to get new coverage after losing Montana Medicaid?
You have 90 days after your Montana Medicaid ends to pick a Marketplace plan at healthcare.gov, which serves Montana. The federal site states that people who lost Medicaid or CHIP coverage in the past 90 days can qualify for a Special Enrollment Period, and you may be able to apply shortly before your coverage ends so the new plan starts without a gap. For example, if Montana Medicaid ends October 31, 2026, your window runs through January 29, 2027. Miss it and you wait for Open Enrollment, which begins November 1, 2026 for 2027 plans. Confirm the closing date at healthcare.gov.
Can I re-apply for Montana Medicaid after losing it?
Yes. Montana Medicaid accepts applications year-round at apply.mt.gov or by phone at 1-888-706-1535. If you lost coverage for a paperwork reason, such as a missing renewal form or unverified income, re-applying with the right documents often restores coverage. If your projected 2026 income is at or below 138% FPL, which is $22,025 for one person or $45,540 for a family of 4, you can qualify even if you were terminated before. Apply to Medicaid and price a Marketplace plan at the same time, because the 90-day Marketplace clock keeps running while the state reviews your file.
What happens to my children's coverage after I lose Montana Medicaid?
Children are evaluated separately. Healthy Montana Kids (HMK), Montana's CHIP, covers children up to 261% FPL in 2026, roughly $86,100 a year for a family of 4, so children often stay eligible even when a parent loses Medicaid. Apply for HMK at apply.mt.gov with proof of income and identity. HMK is open year-round, so no Special Enrollment Period is needed. If a child does not qualify, healthcare.gov plans with premium tax credits are the backup, and the child can be added during the same 90-day window.
What documents do I need to enroll after losing Montana Medicaid?
Gather your DPHHS termination notice, pay stubs or an employer letter for projected 2026 income, Social Security numbers for everyone applying, photo ID, proof of Montana residency, and immigration documents if applicable. Healthcare.gov may ask you to upload the termination letter to verify the Special Enrollment Period. If you lost the notice, call the Montana Public Assistance Helpline at 1-888-706-1535 for a copy that shows the end date and the reason. Upload clear images, since a missing page is the most common reason an SEP application stalls.
What if I miss the 90-day window after losing Montana Medicaid?
Missing the window means you wait for the next Open Enrollment Period, which begins November 1, 2026 for 2027 coverage (confirm the closing date at healthcare.gov), and you may have months with no insurance. You can still re-apply for Montana Medicaid or Healthy Montana Kids at any time if you qualify. Another qualifying life event, such as a move, marriage, or birth, can open a new SEP. Short-term plans are not ACA coverage and may deny preexisting conditions, so treat them with caution.
What is the difference between COBRA and the Marketplace after losing Medicaid?
COBRA applies only when you had employer coverage that also ended, and it is not a substitute for Medicaid. COBRA costs 102% of the full premium, roughly $400 to $900 a month for one adult in 2026, with a 60-day election window. Marketplace plans through healthcare.gov are usually cheaper because premium tax credits reduce costs for incomes up to 400% FPL ($63,840 single, 2026). Choose COBRA only to keep a specific specialist or a met deductible. Compare the plans side by side before the 90-day window closes.
Do I qualify for Montana Medicaid or a subsidy in 2026?
Montana adults 19 to 64 qualify for Medicaid at or below 138% FPL in 2026: $22,025 for one person, $29,863 for two, $37,702 for three, and $45,540 for four. Above that line and up to 400% FPL ($63,840 single, $132,000 family of 4), Marketplace premium tax credits apply. Above 400% FPL you pay full price because the subsidy cliff returned in 2026. Use projected 2026 income, not last year's, and run the CoveredUSA screener to see which program fits.
Do the new federal Medicaid work requirements affect my Montana coverage?
Possibly. Federal H.R. 1 requires work or community engagement requirements for expansion adults by January 1, 2027, typically 80 hours a month, plus eligibility renewals every six months. Montana DPHHS targeted an earlier start, and the dates and exemption rules have changed during 2026, so verify the current schedule at dphhs.mt.gov. Exemptions generally include medical frailty, pregnancy, and caring for a child or another person. If you are terminated for non-compliance, you still have the 90-day Marketplace SEP and can cure the problem and re-apply.
