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For your information:

After you apply, end your session to protect your data. Your session will automatically expire after 1 hour and 5 minutes from the beginning of your session, so please log in or submit your application before that time to avoid losing your progress.

Montana Medicaid Community Engagement Reporting (Form HCS 494)

Report your monthly work, school, training, or volunteer hours for Montana Medicaid.

1 of 5 Reporting Month & Activities

Are you between ages 19 and 64 and reporting monthly hours for Montana Medicaid?

If you need to request an exemption from community engagement requirements, please contact Montana DPHHS or visit medicaidchanges.mt.gov.

Please submit a separate report for each calendar month.

Which activities did you complete this month?

Select all that apply. You can combine different activities to reach 80 hours per month.

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