MICHEL MARTIN, HOST:
The Trump administration is launching work requirements for many Medicaid recipients, going further than what some conservative states asked for. In Montana, Katheryn Houghton with our partner KFF Health News reports.
KATHERYN HOUGHTON: For decades, Medicaid has provided low-cost health coverage to people who otherwise can't afford it, qualifying mainly dependent on income. But by January, millions of people will have to prove they're working, volunteering or going to school to keep Medicaid benefits.
(SOUNDBITE OF ARCHIVED RECORDING)
MEHMET OZ: We need to get people to try to work. It's a path to prosperity.
HOUGHTON: That's Dr. Mehmet Oz, who leads Medicaid, at a press conference this summer. Requiring Medicaid recipients to work has been a goal for many conservatives for years. The Trump administration has made it a priority. But the way that some states like Montana initially envisioned it, work requirements would never have applied to people who are homeless.
TYWON PUGH: (Singing) Sitting on the dock of the bay.
HOUGHTON: Tywon Pugh, who loves to sing, has been homeless in Missoula, Montana, for about the last year. He's 46 and typically sleeps outside. Music helps him cope.
PUGH: If it's music, it'll calm me down. Oh, yeah.
HOUGHTON: Pugh has seizures that make it hard to find and keep a job.
PUGH: They call me a liability to the job site. If I spazzed out and somebody got hurt, I am a liability.
HOUGHTON: When Pugh lost work in the past, his wife of 10 years covered the rent until he found the next job, but she suddenly died last year. He started drinking more, which makes managing his seizures extra hard.
PUGH: When she passed away, my whole base was depleted.
HOUGHTON: Pugh takes medicine that keeps his seizures at bay. Medicaid pays for that, and it would pay for an addiction treatment program, which he wants. Pugh's goal is to get healthy enough to work again, but he's worried. Montana just started requiring Medicaid recipients to prove they're working, including people who are homeless because that's now a federal requirement.
PUGH: My Medicaid is still active, but when are they going to cut that off from me? I can't get employed. How am I supposed to survive?
HOUGHTON: There are exceptions to the new work requirements. People who don't have to meet them include those with disabilities, caregivers of young kids and anyone older than 64. Almost everyone else has to prove they're too sick to work. Many homeless people, including Pugh, could qualify for one of those exemptions, but providing the paper trail of proof can be especially hard.
DUSTIN GOSS: It can seem so simple, but these things stack up so quickly.
HOUGHTON: Dustin Goss is a case manager at Samaritan House, a homeless shelter in Kalispell, Montana.
GOSS: You can't really worry about getting paperwork done when you don't know where you're eating today, or you don't know where you're sleeping, or you've got an infection on your leg that keeps getting worse.
HOUGHTON: Once people start to stabilize, they often do find work. Cassidy Kipp, who heads the homeless shelter, says even then, documenting that work can get hard.
CASSIDY KIPP: We have a lot of, like, gig jobs, so you're going to help somebody clear out a storage unit. You're not necessarily going to have a pay stub associated with that, nor are you going to want to go up to the dude that just hired you off the flyer and be like, can you write a work verification?
ATARAH SIDEY: Knock, knock. Hello, hello. Hi.
PUGH: How are you doing, young lady?
HOUGHTON: Back in Missoula, Tywon Pugh meets with his doctor, Atarah Sidey. This clinic, run by Partnership Health Center, charges on a sliding scale and will see Pugh even if he loses Medicaid. But if too many of their patients don't have Medicaid, that leaves a big financial hole. These clinics typically only provide primary care, and Sidey says Pugh was booted from the neurology clinic that manages his seizures.
SIDEY: You were dismissed from their care because of three no-shows.
PUGH: I have gone through a terrible roller coaster.
HOUGHTON: Pugh says he's still mourning his wife. He usually has to find a new place to sleep every night, and staying away from alcohol is hard.
PUGH: I would not have been capable to show up to an appointment.
HOUGHTON: Dr. Sidey refers Pugh to the other neurologist in town. They talk about finding him treatment. And Pugh's meeting with a social worker to try to keep his Medicaid. Montana has a three-month grace period before people without jobs lose Medicaid. If he can manage his seizures and addiction, he might be able to find a job by then, and he wants to.
PUGH: It's just that if I don't make the effort...
SIDEY: Yep.
PUGH: ...At changing...
SIDEY: Yeah.
PUGH: ...It ain't...
SIDEY: Yeah.
PUGH: ...Going to happen. And then...
SIDEY: Yeah.
PUGH: ...I'm going to end up found on the side of the road somewhere. So...
SIDEY: And you got this, Tywon. You can do this.
HOUGHTON: For now, though, his priority is having a safe place to sleep. It's stressful, but singing helps.
PUGH: (Singing) Sitting in the morning sun. I'll be sitting when the evening comes.
HOUGHTON: I'm Katheryn Houghton in Missoula, Montana.
(SOUNDBITE OF SONG, "(SITTIN' ON) THE DOCK OF THE BAY")
OTIS REDDING: (Singing) Watching the ships roll in.
MARTIN: Katheryn is with our partner KFF Health News.
(SOUNDBITE OF SONG, "(SITTIN' ON) THE DOCK OF THE BAY")
REDDING: (Singing) Roll away again. Yeah. I'm sitting on the dock of the bay. Transcript provided by NPR, Copyright NPR.
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