ROUNDUP, Mont. — Taya Hailstone has been cancer-free for five years, but the lasting effects of childhood Hodgkin lymphoma still make everyday tasks difficult. Her intestines were partially removed after tearing during treatment, leaving her vulnerable to severe dehydration, while nerve damage and other side effects can cause brain fog, swollen hands and feet, and sudden exhaustion. Despite those limitations, Montana’s Department of Public Health and Human Services determined last year that Hailstone no longer qualified for low-cost disability coverage through Medicaid. The decision came after officials learned she had stopped receiving Social Security disability payments — a choice Hailstone made because she hoped to recover enough to work and save money beyond the program’s strict income limits. The state did not seek medical records from the clinicians treating Hailstone before making its determination, according to letters from her doctors. Her coverage was shifted to the Children’s Health Insurance Program three months before she turned 19. Hailstone has kept Medicaid while appealing the decision. She said losing coverage would make it impossible to afford the care she needs, including physical and occupational therapy and mental health treatment. “It feels like this process was made to make you give up,” Hailstone said. Hailstone lives with her mother in Roundup, a central Montana town of about 2,000 people. The pair regularly makes the nearly two-hour round trip to Billings for specialized care. Hailstone typically has three medical appointments each week. Her mother, Kyla Hailstone, said the state has not clearly explained how it evaluated her daughter’s disability and that the appeal process has been slow. Taya Hailstone qualified for disability through the federal government as recently as 2024, roughly a year before Montana ended her disability-based eligibility. Montana officials can accept a Social Security Administration disability decision or conduct their own review. Jon Ebelt, a spokesperson for the state health department, said the agency does not comment on individual Medicaid cases but accepts federal disability determinations and may perform an internal review when a person lacks one. He said the state remains committed to helping eligible residents obtain coverage. Megan Dishong, deputy director of the Montana Legal Services Association, said the outcome of a state disability review can depend heavily on the state’s capacity to process cases. “Things fall through the cracks,” Dishong said. Hailstone’s case comes as Montana and other states prepare to enforce new federal Medicaid work requirements. Under the law passed by Congress last year, an estimated 18.5 million Medicaid enrollees will eventually have to show that they are working, attending school or volunteering to retain coverage, according to the Congressional Budget Office. More than 40% of Medicaid expansion enrollees have a chronic health condition, according to KFF. People considered medically frail or too sick to work can qualify for an exemption. But advocates and attorneys say states face a difficult task determining who qualifies, particularly when medical conditions fluctuate or records are incomplete. Montana began checking work-status requirements in July and has established a three-month grace period. The state does not plan to disenroll people for failing to comply until October. State officials have said they will automatically review available medical records that could support an exemption. Advocates question whether that system will be sufficient. Families USA president Anthony Wright said the new process could affect millions of people. Pamela Herd, a University of Michigan social policy professor who studies barriers to public benefits, said programs become fundamentally inaccessible when applicants need legal help simply to understand their eligibility. “When we’ve designed public programs in ways that people can’t figure out whether they’re eligible without consulting lawyers, we’ve done something wrong,” Herd said. Twenty-five states sued the Trump administration in June over federal rules governing medical-frailty exemptions, arguing the standards are too difficult for patients to meet and states to administer. That case remains pending. The Congressional Budget Office estimates that more than 5 million people could lose Medicaid coverage by 2034 because of the work requirements. Medical providers and advocates also warn that doctors will face additional paperwork and responsibility in documenting whether patients qualify for exemptions. Hailstone is reapplying for Social Security disability payments. Approval would limit how much she could earn, but it would also restore a direct path to Medicaid eligibility. “If I lose this, this is life-changing,” Hailstone said.