MISSOULA, Mont. \u2014 Tywon Pugh has seizures that make it hard to find and keep a job.<\/p>\n
\u201cThey called me a \u2018liability to the job site,\u2019\u201d Pugh said, recalling the words of his manager when a seizure cost him his last job at a fast-food restaurant in this western Montana city.<\/p>\n
When the 46-year-old lost work in the past, his wife of 10 years covered their rent and he tended to their home until he found another job. But his wife died last year. Soon after, Pugh became homeless. His problem with alcohol became worse, which made managing his seizures more difficult.<\/p>\n
\u201cWhen she died, my whole base was depleted,\u201d Pugh said.<\/p>\n
Medicaid pays for the prescriptions that keep Pugh\u2019s seizures at bay. The government-subsidized health coverage would also pay for an addiction treatment program that Pugh said he has tried to get into, but he was told there\u2019s a waitlist.<\/p>\n
Pugh\u2019s goal has been to get healthy enough to work again. But he\u2019s worried about being able to keep the Medicaid coverage he needs to get to that point.<\/p>\n
Early Embrace of New Rules<\/strong><\/p>\n In the spring, the federal government finalized regulations requiring millions of people who receive Medicaid benefits to prove they\u2019re working, volunteering, or going to school to keep their coverage. States have until January to begin those checks. Montana, Arkansas, and Nebraska have already started implementing them.<\/p>\n The Trump administration\u2019s federal work requirements exempt certain groups of people: those with disabilities, those older than 64, pregnant people and Native Americans, among others. To receive an exemption, anyone without a clear-cut qualification \u2014 such as through their age or disability status \u2014 will have to prove they\u2019re too sick to work.<\/p>\n But the administration decided that being homeless isn\u2019t a medical condition and can\u2019t count as an automatic out from having to meet the new requirements. Many conservative policymakers support work requirements, and some states have attempted to implement such rules for years. At least four states \u2014 Montana, Arizona, Kentucky, and Utah \u2014 previously proposed policies that included homelessness as an exemption.<\/p>\n But federal officials have said that\u2019s not allowed. In an email to KFF Health News, the Centers for Medicare & Medicaid Services declined to provide a comment on the record. But the agency confirmed that states must stick to the federal government\u2019s list of exemptions. Homelessness in the U.S. increased by 27% from 2013 to 2025, according to data<\/a> from the Department of Housing and Urban Development. Last year, about 746,000 people were homeless<\/a>.<\/p>\n Many, like Pugh, qualified for Medicaid, though the number of enrollees who are homeless is difficult to measure. In 2023, 55% of patients<\/a> who received medical or behavioral health services through one of the nation\u2019s roughly 300 Health Care for the Homeless<\/a> programs were enrolled in Medicaid.<\/p>\n![\"\"](\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/07\/Partnership-Health-Center02_3840x2560web.jpg?w=840\")