Nursing Homes in Montana: Cost & Medicaid (2026)

A nursing-home stay in Montana runs modestly below the national median, but it is still more than most families can pay out of pocket for long.1 Nationally, a semi-private room medians about $114,975 a year. For most long-term residents, what makes a stay affordable is Montana Medicaid, which pays for nursing-facility care once a person meets the level-of-care and financial rules.

This guide covers how Montana oversees its nursing homes, what a stay costs, who pays for it (Medicare's limited skilled benefit versus Medicaid for long-term care), and how to check a facility's record before you choose one.

In This Guide

• Key Takeaways
• How Montana Oversees Nursing Homes
• What a Nursing Home Costs in Montana
• Who Pays: Medicare vs. Medicaid
• How to Vet a Facility
• Frequently Asked Questions

How Montana Oversees Nursing Homes

A nursing home, often called a skilled nursing facility, provides 24-hour licensed nursing care, help with daily activities like bathing and dressing, and rehabilitation services such as physical, occupational, and speech therapy. That round-the-clock nursing is the line separating it from assisted living, which is built for people who need help with daily tasks but not constant skilled care. Before you weigh cost or payment, it helps to know who watches over these facilities in Montana, because that oversight is what gives you a record to check.

Two layers of regulation apply, and they work together. At the state level, nursing facilities are licensed by the Licensure Bureau of the Montana DPHHS Office of Inspector General (formerly the Quality Assurance Division).2 A facility that takes part in Medicare or Medicaid is also certified, and that certification sits with a separate unit of the same office, the Certification Bureau, which publishes long-term care facility survey results. Medicare Care Compare combines health inspections, staffing, and quality measures into an overall rating for each certified nursing home from one to five stars.2

There's also a free advocate you should know about before you need one. Montana's Long-Term Care Ombudsman Program helps residents of long-term care facilities understand and exercise the rights the law guarantees them, and its ombudsmen can investigate claims of abuse and of residents being moved or released without proper notice or cause.2 The program is decentralized: the state ombudsman oversees it, while local area agencies on aging, county councils on aging, and other contracted groups employ more than 30 certified ombudsmen, so the number to call is usually a local ombudsman rather than the state office. It advocates and resolves complaints but does not license or inspect, so it's a different kind of help than the state survey process. An ombudsman who regularly visits facilities in your area can tell you things a brochure never will.

What a Nursing Home Costs in Montana

Nursing-home care is among the priciest long-term care in Montana, and the numbers are large enough that paying privately for years is out of reach for most families. According to the CareScout 2025 Cost of Care Survey, the national medians are about $114,975 a year (roughly $9,581 a month) for a semi-private nursing-home room and about $129,575 a year (roughly $10,798 a month) for a private room.1 These are medians from an industry survey, not government rates and not maximums. The figure at any one facility can land higher or lower depending on location, room type, and how much care a resident needs.

What stands out about Montana is that nursing-home costs run modestly below the national line even though some other care does not. Montana's nursing-home medians sit under the national figures above, while in-home care in the state runs at or above the national level. So a Montana family weighing settings won't find nursing-home care as far above the alternatives as families in many other states do.1

A semi-private nursing-home room still costs well more than assisted living, whose national median is about $74,400 a year.1 That gap is the reason families look hard at whether assisted living or in-home care can meet the need before moving to a nursing home, and it's the reason most long-term nursing-home residents in the state end up relying on Medicaid rather than paying privately for years.

Who Pays: Medicare vs. Medicaid

People often assume Medicare covers a nursing home. It does, but only in a narrow way, and confusing the two programs is one of the most expensive mistakes a family can make. Here's how they divide the work.

Medicare covers short rehab, not a long stay. Medicare Part A covers skilled nursing facility care only on a short-term basis after a hospital stay. To qualify, a person generally needs a qualifying inpatient hospital stay of at least three consecutive days, then enters a Medicare-certified facility for skilled care related to that stay. Medicare then covers up to 100 days per benefit period: days 1 through 20 at $0 a day after the $1,736 Part A deductible (usually already paid if the hospital stay fell in the same benefit period), days 21 through 100 at a daily coinsurance of $217 in 2026, and nothing after day 100.3 Time under observation or in the emergency room doesn't count toward the three days, but missing them isn't always the end: some Medicare Advantage plans and doctors in approved Accountable Care Organizations can waive the three-day rule, and re-entering a facility within 30 days of leaving doesn't require a new hospital stay.3 Medicare does not pay for long-term custodial care, the ongoing help with daily living that someone needs when skilled rehab is finished.3 That is the care most families worry about affording, and it's where Medicaid takes over.

Medicaid covers long-term nursing-facility care. Montana Medicaid, administered by DPHHS, pays for nursing-home care for people who meet a nursing-facility level of care and the financial rules.4 Qualifying turns on two findings on separate tracks: a level-of-care assessment on the medical side and the income and asset rules on the money side.

Montana's income rules are where it differs from most states, so it's worth slowing down here. Most states use a flat special income limit for long-term-care Medicaid, set at 300% of the SSI federal benefit rate. Montana does not; KFF reports it as the only state without that optional pathway. Instead it runs a medically needy spend-down.4 In practice, an applicant whose income runs above the standard isn't automatically disqualified the way they would be under a hard cap. They can still qualify by spending the excess down on their care, and once enrolled, a nursing-home resident contributes most of their monthly income toward the cost of care while keeping a personal needs allowance of $50 a month. The countable-asset limit is generally $2,000 for a single applicant.4

A married couple is not held to the single-person numbers. When one spouse enters a nursing home and the other stays in the community, federal spousal-impoverishment rules let Montana protect savings for the at-home spouse. Montana's community spouse resource allowance is the greatest of half the couple's countable resources (capped at $162,660 in 2026), a $32,532 minimum, or an amount a hearings officer or court sets, so it can exceed $162,660.4 Two more rules shape long-term-care eligibility. Montana applies a five-year, or 60-month, look-back to assets transferred for less than fair value, which can trigger a penalty period of ineligibility.4 And as federal law requires, the state recovers from the estates of people who received long-term-care Medicaid at age 55 or older.4 If a nursing home isn't the right fit, Montana also funds home and community-based care, mainly through the Big Sky Waiver, for people who would otherwise need nursing-facility care; a waiver recipient must be financially eligible for Medicaid and meet the minimum nursing-facility level of care.4 Because these rules are detailed and the spend-down math depends on your own income and expenses, it's worth getting professional advice before assuming any outcome.

How to Vet a Facility

Quality varies widely from one nursing home to the next, and Montana gives you several free tools to check a place before you commit. Use more than one, because each shows you something the others don't.

Start with the federal scorecard. On Medicare Care Compare, CMS rates every Medicare- and Medicaid-certified nursing home from one to five stars, combining an Overall rating with separate ratings for health inspections, staffing, and quality measures.2 Read the component ratings, not just the headline star count, because a strong Overall can hide a weak staffing or inspection score. The staffing numbers deserve a close look on their own, since how many nurses and aides a facility keeps per resident shapes day-to-day care more than almost anything else.

Then go to the source of those ratings. When you tour a facility, ask to see its most recent state survey results, which the DPHHS Certification Bureau also posts, and watch for a pattern of repeat deficiencies rather than reacting to a single old citation.2 Finally, call your local long-term care ombudsman before you sign anything. An advocate who visits facilities in your area regularly can give you an honest, on-the-ground read on a specific place that no rating captures.2

Learn More

Find personalized help comparing nursing homes in Montana at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.