Pugh has recurring seizures that make it hard to find a job, which worries him as Montana implements Medicaid work requirements. The Trump administration’s federal work requirements exempt certain groups of people: those with disabilities, those older than 64, pregnant people and Native Americans, among others. Many conservative policymakers support work requirements, and some states have attempted to implement such rules for years. At least four states — Montana, Arizona, Kentucky, and Utah — previously proposed policies that included homelessness as an exemption. Most states will begin to implement the Medicaid work requirements in January.