Montana Medicaid Changes: Maintaining Access to Therapy and Mental Health Care in Bozeman
Ann Matney | May 4, 2026
The state of Montana recently announced upcoming changes that will affect many adults enrolled in Medicaid Expansion. These changes, passed through federal legislation in 2025, will begin rolling out in 2027 and will impact how some people maintain their Medicaid coverage.
For individuals receiving therapy, counseling, and mental health treatment, understanding these changes is important to avoid disruptions in care.
At Sub Rosa Therapy in Bozeman, our mission is to expand accessibility to mental health services, especially for people using Medicaid coverage. We are sharing this guide to help clients and community members understand what is changing and how to stay covered so they can continue receiving the care they need.
At the end of this blog, you’ll find a list of community-based nonprofit organizations in Bozeman, Montana that may offer opportunities to fulfill volunteer hours for community engagement requirements.
Why Medicaid Matters for Therapy and Mental Health Access
Montana Medicaid provides essential access to therapy, counseling, psychiatric care, and trauma-informed mental health treatment for many individuals and families across the state.
For clinics like Sub Rosa Therapy, Medicaid allows people to receive services such as:
Mental health therapy for anxiety, depression, and PTSD
Psychiatric medication management
Innovative treatments such as Spravato (esketamine) for treatment-resistant depression when clinically appropriate
For many people in the Gallatin Valley, Medicaid coverage is what makes mental health care accessible and sustainable. Maintaining that coverage can be essential to continuing therapy and counseling services.
New Community Engagement Requirement
Beginning in 2027, some adults enrolled in Montana Medicaid Expansion will need to complete 80 hours per month of qualifying activities in order to maintain their health coverage.
Qualifying activities may include:
Employment
Volunteer work or community service
Workforce training or job readiness programs
Attending college, university, or vocational school at least half-time
Activities can be combined to reach the required hours. For example, someone might work 60 hours in a month and volunteer for 20 hours to meet the requirement.
These activities may be verified through documentation such as pay stubs, school enrollment records, volunteer logs, or participation letters from organizations. A list of nonprofit organizations in Bozeman that may offer opportunities to fulfill volunteer hours for community engagement requirements is listed at the end of this blog.
Many Medicaid Members Will Be Excluded
Not everyone enrolled in Medicaid Expansion will need to meet the community engagement requirement.
Common exclusions include:
Pregnancy or postpartum coverage
People with serious medical or mental health conditions
Individuals in substance use disorder treatment
Caregivers for children under age 14
Caregivers for individuals with disabilities
Veterans with disability status
Individuals receiving SSI, SSDI, or Medicare
Individuals under age 19 or over age 65
Some individuals receiving ongoing mental health treatment may qualify as medically frail, though the state is still finalizing how that category will be defined.
Excluded individuals may still need to verify their eligibility category during the Medicaid renewal process.
Medicaid Eligibility Reviews Will Happen Every Six Months
Currently, most Medicaid members renew their coverage once per year.
Beginning in January 2027, most Medicaid Expansion members will need to complete eligibility redetermination every six months instead.
During these reviews, the state will verify:
Income
Household composition
Community engagement activity (if applicable)
Eligibility exclusions
If the state cannot automatically verify eligibility through available data, members will receive a notice and will have 30 days to provide documentation.
Keeping addresses and contact information up to date with Medicaid will be especially important during this transition.
Medicaid Coverage for Spravato Treatment
Many people are not aware that Montana Medicaid may cover Spravato (esketamine) for individuals experiencing treatment-resistant depression, when clinical criteria are met.
Spravato is an FDA-approved medication used for individuals who have not responded to traditional antidepressant treatments. When combined with therapy and psychiatric care, it can provide meaningful relief for some people experiencing severe depression.
At Sub Rosa Therapy, Spravato treatment is provided within a comprehensive care model that includes:
Therapy and counseling
Psychiatric evaluation and medication management
Integration and supportive care
Trauma-informed mental health treatment
When Medicaid eligibility is maintained and clinical criteria are met, coverage can make this treatment accessible to patients who might not otherwise be able to receive it.
Maintaining Medicaid enrollment is therefore especially important for individuals relying on these advanced treatment options.
What Happens if Medicaid Coverage Ends
If someone loses Medicaid coverage because they did not meet eligibility requirements, they can reapply once they meet the requirements again.
There is no permanent disqualification period, and individuals also retain the right to appeal eligibility decisions.
Steps Medicaid Members Can Take Now
To avoid disruptions in therapy, counseling, or mental health treatment, Medicaid members should take several proactive steps:
Keep mailing addresses updated with Medicaid
Carefully read all mail from Montana DPHHS
Create an account through the state portal at apply.mt.gov
Save documentation related to work, volunteering, or school participation
Being prepared for redetermination can help ensure continued access to therapy and mental health care.
Community Engagement Opportunities in the Gallatin Valley
For individuals who meet the criteria for the community engagement requirement, volunteering can be one way to fulfill qualifying activity hours.
The Gallatin Valley has many nonprofit organizations that support community wellbeing, arts, education, youth mentorship, environmental stewardship, and social services.
Below are several organizations in the Bozeman area that frequently offer volunteer opportunities.
Arts, Culture, and Education
Bozeman Friends of Music - supports and strengthens music programming in the Bozeman public schools
Museum of the Rockies - Bozeman museum and research center focused on natural history and dinosaur fossils
American Computer & Robotics Museum - Bozeman museum dedicated to preserving and sharing the history of computing, robotics, & information technology
The Extreme History Project - shares the region’s social and cultural history through public programs, exhibitions, and research
Tinworks Art – provides community arts programming, exhibitions, performances, and creative events that connect artists and the public
Youth, Mentorship, and Education
Big Brothers Big Sisters of Big Sky Country - connects youth with supportive adult mentors to promote confidence, academic success, and positive life outcomes
Big Sky Youth Empowerment (BYEP) - provides outdoor adventure programs and mentorship to help young people build resilience, leadership skills, and healthy relationships
Gallatin County 4-H Foundation - supports youth education and leadership development through hands-on learning programs in agriculture, science, community service, and life skills
Gallatin Valley YMCA - offers fitness, recreation, youth development programs, childcare, and wellness services that promote healthy living and community connection
Sunrise Movement Bozeman - organizes community members around environmental action, climate education, and civic engagement
Community Support and Social Services
HRDC (Human Resource Development Council) - provides housing assistance, food security programs, transportation services, and other resources that help individuals and families achieve stability and self-sufficiency
Family Promise of Gallatin Valley - helps families experiencing housing instability access shelter, housing support, and social services
Roots Family Collaborative - supports families with young children through parenting education, early childhood resources, and community connection
Cancer Support Community Montana - provides free emotional support, education, and community programs for individuals and families affected by cancer
Recovery and Peer Support
The Fellowship Hall - a Bozeman community space that hosts 12-step recovery meetings and provides peer support for individuals working toward sobriety
Befrienders - connects older adults with volunteers to build meaningful intergenerational friendships and reduce social isolation
Suffer Out Loud - a mental health nonprofit focused on suicide prevention through peer support, storytelling, and community education that reduces stigma around mental health struggles
We Are HER - provides resources, advocacy, and community support for survivors of sexual abuse and trauma
Mountains of Courage - offers education, conversation, and community support around death, dying, and end-of-life care
Haven - provides confidential support, legal advocacy, counseling, and a safe place to stay for anyone and everyone impacted by domestic violence, sexual assault, sex trafficking, and stalking
Community Inclusion and Equity
Bienvenidos a Gallatin Valley - supports connection, cultural exchange, and mutual support within Bozeman’s Latino community
Montana Racial Equity Project - works to advance racial equity and social justice through community education, advocacy, and leadership development
Hopa Mountain - strengthens rural and tribal communities through youth leadership programs, scholarships, mentorship, and community development initiatives
Outdoor Recreation and Community Health
Eagle Mount - provides adaptive recreation and therapeutic programs for children and adults with disabilities and other health challenges.
Bozeman Bike Kitchen - A community bike workshop that helps people learn bicycle repair, access affordable bikes, and promotes transportation and recreation through cycling
Warriors & Quiet Waters - supports post-9/11 combat veterans through outdoor recreation programs that promote healing, connection, and community
Community Leadership and Entrepreneurship
Prospera Business Network - supports entrepreneurs and small businesses in southwest Montana through business advising, training programs, and community economic development initiatives
If volunteering is used to meet Medicaid community engagement requirements, individuals may need to track volunteer hours and obtain verification from the organization. Documentation may include volunteer logs, supervisor signatures, or program participation letters.
For the most current information about Medicaid changes in Montana, please visit: medicaidchanges.mt.gov
Supporting Mental Health Accessibility in Montana
Changes to healthcare policy can feel confusing and overwhelming, especially when they affect access to therapy, counseling, and mental health care.
At Sub Rosa Therapy in Bozeman, we believe mental health treatment should remain accessible and supportive during times of change. Our clinic works closely with Medicaid patients and community partners to help ensure individuals continue receiving the care they need. See our Insurance and Pricing page for more information.
While we cannot make eligibility determinations, we are always happy to help connect clients with resources that support continued coverage and access to therapy.
