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Medicaid Work Rule Leaves Homeless People in the Cold

Homeless enrollees may miss reporting deadlines because unstable housing, lost documents and health problems make it hard to prove they are working.

  • The federal government finalized regulations this spring requiring millions of Medicaid recipients to prove they are working, volunteering, or studying to maintain coverage starting in October.
  • While federal rules exempt specific groups like the elderly or disabled, homelessness is not classified as a medical condition under current policy, leaving vulnerable populations without automatic protection.
  • Pugh, a Missoula, Mont. resident experiencing homelessness, struggles with seizures that make employment difficult and expressed concern the administrative requirements could jeopardize his Medicaid prescription coverage.
  • Health centers report managing patient verification poses significant administrative challenges, and administrators warn clinics may struggle to cover financial shortfalls if too many patients lose coverage.
  • Federal budget officials project these work requirements will reduce Medicaid enrollment by 2034, while debate continues regarding whether current medical frailty standards provide sufficient protection for vulnerable populations.
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The McDowell NewsThe McDowell News
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Medicaid rule leaves homeless in the cold

MISSOULA, Mont. — Tywon Pugh has seizures that make it hard to find and keep a job.

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The Columbian broke the news in Vancouver, United States on Saturday, August 15, 2026.
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