Montana
Procedural barriers complicate Medicaid enrollment for the unhoused
On a cold February morning at the Flathead Warming Center in Kalispell, shelter guests got ready for the day, eating breakfast, or figuring out if the bus was running on time.
Tashya Evans was in the parking lot smoking a cigarette while she waited for help with her Medicaid application.
Evans is one of about 120,000 Montanans who lost Medicaid as the state re-evaluated everyone’s eligibility. That number is still growing as the state releases more data.
About two-thirds of those who were kicked off state Medicaid rolls lost it for technical reasons like incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates nationwide, according to a Kaiser Family Foundation analysis.
Even unsheltered people like Evans, who still qualify, are losing their health insurance. That’s despite the state saying publicly it would use datasets like social security and disability to automatically renew people who likely still qualify for Medicaid.
Evans said she lost coverage in September because she didn’t receive paperwork as she moved from Great Falls.
That’s forcing her to forgo her blood pressure medication and pause dental work. She thinks her blood pressure has been ok, but waiting for the dentist has been hard.
“The teeth broke off. My gums hurt. There’s sometimes where I’m not feeling good and I don’t want to eat,” she said.
She sat down in a spare shelter office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population in the Flathead Valley.
Evans recounted all the struggles she’s had.
She tried asking for help at the local state public assistance office. She said staff there don’t have time to answer all her questions about which forms she needs to fill out or walk through the paperwork with her. She tried the state help line, but she couldn’t get through.
“You just get to the point where you’re like, ‘I’m frustrated right now. I have other things that are more important, so let’s not deal with it,’” she said.
Evans said she needs to spend her time looking for a job, finding her next meal and a place to sleep. Sitting on the phone most of the day isn’t feasible.
There’s no public data on how many unhoused people in Montana, or nationwide, have lost Medicaid, but homeless service providers and experts say it’s a big problem.
Montana health officials said they provided training to prepare homeless service providers.
State health department Director Charlie Brereton also resisted calls from Democratic state lawmakers to pause the redetermination process.
“I’m confident in our redetermination process,” Brereton told lawmakers. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.”
Redetermination went on as planned, ending in January, four months ahead of the federal deadline.
Those helping unsheltered people who have lost coverage said they have spent much of their time trying to help people get in touch with the state Medicaid office to provide them with the correct information.
Sorting through paperwork mistakes has also been a headache, said Crystal Baker, a case manager at HRDC, the homeless shelter in Bozeman.
“We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again. Now, they have to wait two to three months without insurance,” she said.
Federal health officials warned Montana and other conservative states that have been unenrolling high rates of people for technicalities. The agency also warned states for having unreasonable barriers to accessing assistance, such as long hold times on help lines. CMS said that it could force states to halt their process, but so far hasn’t done so.
However, experts said blue states are also kicking homeless people off their rolls and that the redetermination has been chaotic everywhere. Because of the barriers unsheltered people face, it’s easy for them to fall through the cracks.
“It doesn’t seem like such a big deal to fill out paperwork,” said Dr. Margot Kushel, a primary care provider and a homeless researcher at the University of California, San Francisco. “Put yourself in the position of an elder who’s experiencing homelessness and has lost their vision, who has no access to [a] computer, no access to [a] car, doesn’t have [a] cell phone.”
People can typically get retroactive coverage if they get back on Medicaid after they are kicked off.
Kushel said being without Medicaid for any period can be dangerous for the homeless community, which has high rates of chronic health conditions.
“Being out of your asthma medicine for three days can be life threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.
When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, said Kushel.
Evans, who was able to get help with her application, is likely to regain coverage.
Providers on the ground said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.
Baker, the case manager at the Bozeman shelter, set up several call-backs from the state for one client. The state needed to interview him to make sure he still qualified, but the state never called back.
“He waited all-day long. It was so stressful for him that he just gave up,” she said.
That client ended up leaving the Bozeman area before she could convince him it was worth trying to regain Medicaid.
Baker worries his health will catch up with him before he decides to reapply to Medicaid.
Montana
Escobar, Jayapal, Members of Congress Call on Camp East Montana to be Shut Down – Congresswoman Pramila Jayapal
(Washington, D.C.) – Today, Congresswoman Veronica Escobar (TX-16) – joined by Representative Pramila Jayapal, the Ranking Member of the Immigration Integrity, Security, and Enforcement Subcommittee, and 22 other Members of Congress – sent a letter to Department of Homeland Security (DHS) Secretary Kristi Noem and Immigration and Customs Enforcement (ICE) Acting Director Todd Lyons calling for the immediate closure of Camp East Montana in El Paso. They cite urgent humanitarian concerns following multiple deaths in custody, documented unsafe conditions, and serious deficiencies in medical care.
This marks the fourth letter Congresswoman Escobar has sent to DHS and ICE leadership. The previous three letters have gone unanswered.
The letter can be found in its entirety below and here.
“Secretary Noem and Acting Director Lyons:
We are urgently calling on the Department of Homeland Security (DHS or the Department) and U.S. Immigration and Customs Enforcement (ICE) to shut down Camp East Montana in El Paso, Texas.
Camp East Montana has been operational for six months, and at least three people have died at the site since December 2025: Francisco Gaspar-Andres, Geraldo Lunas Campos, and Victor Manuel Diaz. The El Paso County Medical Examiner has officially ruled Lunas Campos’ death a homicide, citing “asphyxia due to neck and torso compression.”
Camp East Montana was constructed in a matter of weeks and opened before construction was complete and it does not have enough federal staff on-site to provide adequate oversight. Over the last several months, Congresswoman Veronica Escobar, in whose district this facility is located, has sent multiple letters to DHS and ICE regarding concerns about the conditions at Camp East Montana, and has received no responses.
According to detainees, there have been constant and consistent problems at the facility since it opened, beginning with the facility’s poor construction and poor ambient temperature control. Upon opening, the drinking water at Camp East Montana tasted foul and made some detainees sick. Detainees continue to be served inadequate meals, including food that is rotten or frozen; last fall, the facility was also consistently failing to make dietary accommodations for detainees. Detainees have shared that they have sporadic access to outside spaces and recreational areas, and that their dormitory pods are cleaned only once every eight days, despite pods housing up to 72 people at a time. Laundry services are not consistent, and people are washing their clothes in the facility showers. Additionally, the facility experiences flooding and sewage backups when it rains, leading to stagnant water.
One of the biggest concerns with the Camp East Montana facility is the inadequate medical care being provided to detainees. Our offices have heard that only the most ill detainees are referred to the medical unit and that there are inconsistencies as to how soon after arriving detainees are able to undergo initial medical screenings. Detainees with chronic health issues who rely on regimented medications for their health have had difficulty accessing necessary medications, including blood pressure medication and insulin.
At least one of the deaths that occurred in ICE custody, the death of Francisco Gaspar-Andres, appears to partially be the result of poor medical care by staff at the facility. According to ICE’s own account, Gaspar-Andres sought medical attention from facility staff for increasingly serious symptoms, but was only transferred to an area hospital once his condition had severely deteriorated.
In addition to our concerns about poor medical care, we are also aware that detainees have experienced irregular access to their legal counsel, including instances of detainees having only two minutes allotted per phone call every 8 days, which is contrary to ICE’s Detention Standards on access to counsel, and that the belatedly created law library lacks adequate resources for the amount of people currently held at the facility. In January 2026, ICE announced the on-site death of Geraldo Lunas Campos “after experiencing medical distress.” ICE opened an investigation into the death, but did not provide a cause of death. However, The Washington Post later reported that another man detained at Camp East Montana had witnessed guards choking Lunas Campos when he refused to enter a segregated housing unit. Weeks later, the El Paso County Medical Examiner ruled that Lunas Campos had experienced “asphyxia due to neck and torso compression” and ruled his death a homicide.
Lunas Campos is the first detainee to die at Camp East Montana as a result of a use-of-force incident, but we are strongly concerned that he will not be the last if ICE is allowed to continue operating Camp East Montana.
ICE was given $45 billion in taxpayer dollars in the reconciliation bill, $1.2 billion of which were awarded to Acquisition Logistics, LLC, a company with no previous experience managing immigration detention facilities, to build and oversee Camp East Montana. However, in the wake of three deaths in custody so far, continued concerns about conditions at the facility, and ICE’s apparent disinterest in responding to oversight letters from Congress, we do not believe Camp East Montana is being run professionally or responsibly.
Camp East Montana must be shut down. For the safety of everyone at the facility, for an end to abuses to detainees, and for fiscal responsibility to the American people, the site cannot continue to operate. We are calling on DHS and ICE to move to immediately close operations at Camp East Montana.
We look forward to hearing from the Department promptly on this matter.
The other co-signers include Representatives Yassamin Ansari, Nanette Barragán, Yvette Clarke, Lloyd Doggett, Maxwell Frost, Jesús “Chuy” García, Sylvia Garcia, Daniel Goldman, Jimmy Gomez, Henry Johnson, Stephen Lynch, Seth Moulton, Eleanor Holmes Norton, Delia Ramirez, Andrea Salinas, Janice Schakowsky, Darren Soto, Rashida Tlaib, Paul Tonko, Lauren Underwood, Gabe Vasquez, and Nydia Velázquez.
Issues: Immigration
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