Montana Medicaid Income Limits 2026: Eligibility & Assets

Montana Medicaid income limits come in two versions, and which one applies depends on your age and on what you need. If you are under 65 and not seeking long-term care, you are measured on modified adjusted gross income (MAGI): Montana has adopted the ACA expansion, so adults 19-64 are covered up to 138% of the federal poverty level, with no asset test at all.1,2 If you are 65 or older, or applying for nursing-home or waiver care, a different test applies, and being over the line still doesn't get you turned away. Montana is a medically needy state, so an over-income senior qualifies by spending the excess on care, not by being shut out at the door. There's no hard income cap and no Miller Trust to set up. This guide covers both tests for 2026: Montana's MAGI standards, the spend-down, the $2,000 asset limit, what a nursing-home resident keeps, and what a spouse at home is protected from.3

The two Montana Medicaid income limits: which one applies to you

Montana applies two different Medicaid income tests, and the one this guide leads with (the spend-down, the $2,000 asset limit, the spousal protections) is only one of them.3 It is the ABD test, used for people who are 65 or older, blind, or disabled, and for anyone applying for long-term-care coverage. Everyone else is measured against a separate standard: MAGI, or modified adjusted gross income, the test for children, pregnant women, parents and caretaker relatives, and adults under 65 who are not disabled and not seeking long-term care.2

The distinction matters because the two tests use different yardsticks and different rules. If you are under 65 and not applying for nursing-home or waiver care, the $2,000 asset limit on this page does not apply to you.2,3

Montana has adopted the ACA Medicaid expansion, so its MAGI coverage is the full version.1,6 The state's MAGI standards, administered by DPHHS, run as follows.1

Montana's MAGI rules generally add an amount equivalent to a 5%-of-FPL disregard when your income is compared to the standard, so the effective cutoff for each group above runs up to 5 percentage points higher than the net standard shown. That is exactly why the expansion adult group's 133% base standard is usually quoted as 138% FPL.1 Children are covered at 143% FPL here, above the federal floor of 133% FPL that every state must meet.1,7

There is no asset test on the MAGI side. Federal law bars a state from applying any assets or resources test to the MAGI groups, which is the sharpest contrast with the ABD track this page otherwise describes: a working-age adult, parent, or pregnant applicant in Montana is never measured against the $2,000 limit.2 Savings are counted on the ABD and long-term-care pathways, which the statute expressly excepts from that rule, and not on the MAGI ones.2

The parents and caretaker relatives limit: 24% FPL

The 24% FPL standard is the one that surprises families, and it is the group a grandparent raising a grandchild would look to: federal rules cover "parents and other caretaker relatives," not parents alone.1,8 Whether you meet Montana's definition of a caretaker relative is a question for DPHHS.

The reason the number is so low is historical, not accidental. Parents and caretaker relatives are a federally mandatory Medicaid group, but unlike children and the expansion adults they are covered only at the state's old cash-welfare standard: the minimum is the state's AFDC income standard in effect on May 1, 1988, converted to a MAGI equivalent, and the statute ties the group to the state's pre-welfare-reform AFDC criteria as of July 16, 1996.8 The limit is frozen to a welfare standard from decades ago, which is why it sits far below the poverty line. In Montana this pathway matters less than it does elsewhere, because a parent over 24% FPL who is under 65 can usually still qualify through the expansion group at 138% FPL.1

The 65th-birthday cliff

Turning 65 can end Medicaid eligibility even though nothing about the person's income changed. The expansion group Montana covers is written for individuals under 65 years of age, not pregnant, and not entitled to or enrolled in Medicare, at an effective ceiling of 138% FPL, and, being a MAGI group, it applies no asset test.9,2 For one person in 2026 that ceiling works out to roughly $1,835 a month: 138% of the $15,960 annual federal poverty guideline for one person in the 48 contiguous states.4,9

On the 65th birthday that pathway closes, and the same person is generally assessed on the SSI-related ABD track instead, the track the statute expressly excepts from the no-asset-test rule.2 Two things change at once. The income yardstick becomes the SSI federal benefit rate of $994 a month for an individual rather than 138% FPL, and a $2,000 resource test that never applied before appears.10,3

So a 64-year-old Montanan covered at $1,600 a month with modest savings can be over both tests the day they turn 65, without a dollar of their income or savings changing. The same cliff has a second trigger that has nothing to do with age: the expansion group also excludes anyone entitled to or enrolled in Medicare, so someone under 65 who reaches Medicare through disability leaves the group the same way.9

If a 65th birthday or a Medicare enrollment is coming, ask DPHHS which pathway you will be assessed under before your current coverage is redetermined. The spend-down described below is the next thing to understand: in Montana, landing on the ABD track does not mean being turned away, it means being spent down.

How Montana Medicaid income limits work: the spend-down

Montana is a medically needy state: income above the medically needy income standard becomes a monthly spend-down amount, not a reason for denial. The program is administered by the Montana Department of Public Health and Human Services (DPHHS).3 Most families searching this topic assume a high income disqualifies them outright; in Montana, it does not.

That means Medicaid offers a spend-down: if your income is above the standard, the excess becomes your spend-down amount, and once you've incurred that much in medical or care costs, Medicaid covers the rest. A nursing-facility resident reaches the standard automatically, because nursing care costs far more per month than almost anyone's income, so the excess income simply goes toward the bill.

This is why Montana does not require a Qualified Income Trust, also called a Miller Trust. In strict income-cap states, an applicant even one dollar over the limit is locked out unless they route the excess through a special trust. Montana has no such cliff. If your income is high, you spend down; you are never simply "too rich" for long-term-care Medicaid.

The $2,000 asset limit

Separate from income, Montana applies a countable-asset limit of $2,000 for a single long-term-care applicant.3 When both spouses of a married couple need care, each is treated as an individual applicant subject to the $2,000 standard; when only one spouse needs care, the community-spouse protections described below apply instead.

Only countable assets are subject to the limit. Montana, like every state, exempts a long list of assets from the count: your primary residence (subject to the home-equity cap covered below), one vehicle, household goods and personal effects, and prepaid burial arrangements. So the $2,000 applies to things like bank accounts, a second car, and investments, not your home.3

The spousal-impoverishment rules described below let the at-home spouse keep well beyond that $2,000 figure.3,5

Montana nursing home Medicaid: what a resident keeps

When Montana Medicaid pays for nursing-facility care, the resident contributes almost all of their monthly income toward the cost of care. What they keep is the Personal Needs Allowance (PNA), money reserved for the resident's own small expenses like clothing, a haircut, or a phone. Montana sets its PNA at $50/month.3,11

Because Montana uses spend-down rather than an income cap, even a resident with substantial monthly income can qualify for Montana nursing home Medicaid; they simply contribute more of it toward care. For the national picture on how the allowance is set, see our explainer on the Medicaid personal needs allowance.

The five-year look-back

Montana reviews asset transfers made in the 60 months before a long-term-care application.3,12 Giving away money or property for less than fair market value during that window, gifting a grandchild a down payment or signing a house over to a child for a dollar, can trigger a penalty period during which Medicaid won't pay for long-term-care services, even though you're otherwise eligible.

There are legitimate exceptions (transfers between spouses, transfers to a disabled child, certain caregiver-child home transfers) and legitimate planning approaches, but anything done inside the five-year window deserves an elder-law attorney's review first. For the broader toolkit, see our guide to Medicaid planning strategies.

How Montana Medicaid income limits protect the spouse who stays home

When one spouse needs long-term care and the other remains in the community, federal spousal-impoverishment rules keep the at-home spouse from being left destitute. Montana applies the federal figures for 2026:3,5,13

A married couple is therefore in a very different position from a single applicant. The community spouse can hold up to $162,660 in countable assets and keep up to $4,066.50 a month in income while the other spouse receives Medicaid-funded care.5

After death: estate recovery

Like every state, Montana runs a Medicaid estate-recovery program. After a recipient who was 55 or older and received long-term-care services dies, the state may seek repayment from the estate, unless the recipient is survived by a spouse or a minor, blind, or disabled child. Federal exceptions apply, and an undue-hardship waiver exists.3,14 For how estate recovery works and where families have room to plan, see our Medicaid estate recovery explainer.

How to apply in Montana

Montana Medicaid is administered by DPHHS, and you have three ways to apply:

Long-term-care applicants are generally screened to confirm they need nursing-facility-level services; contact DPHHS to confirm the current screening requirements. Apply even if you think you're over the income line. Because Montana spends you down rather than turning you away, many people who assume they're disqualified are not.

If staying home is the goal, ask DPHHS about home- and community-based services (HCBS) waivers. Montana's Big Sky Waiver can fund care in a person's own home or in a community setting rather than a nursing facility, using the same income and asset rules described above.

Learn More

Find personalized help working through Montana Medicaid spend-down and eligibility for your family 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.