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 its income line is not the end of the road. Montana runs a medically needy program for aged, blind, and disabled residents, so income over the line becomes a spend-down you meet with medical bills or a payment to DPHHS, not an automatic denial.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 seeking long-term care. Having a disability does not by itself take you off MAGI: the ABD rules apply only when your eligibility is being decided on the basis of disability.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 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.1,6

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.1,7 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 their mandatory coverage is pegged to the state's old cash-welfare (AFDC) standard, not to a share of the poverty level: the federal minimum is the state's AFDC income standard in effect on May 1, 1988, converted to a MAGI equivalent, and the ceiling is tied to the state's earlier Medicaid levels or its July 16, 1996 AFDC standard raised by no more than inflation.7 Anchored to a welfare benchmark from decades ago, the standard a state sets can sit far below the poverty line, and Montana's 24% is the number to check, not the federal floor.7,1 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 One condition: federal rules let a state cover a parent living with a child under 19 in that group only if the child has Medicaid, CHIP, or other minimum essential coverage.8

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.8,2 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.4,8

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. On Montana's medically needy route, income is now measured against the state's ABD medically needy income level of $525 a month for an individual rather than 138% FPL, with anything above it becoming a spend-down, and a $2,000 resource test that never applied before appears.3

So a 64-year-old Montanan covered at $1,600 a month with savings above $2,000 can be over both lines 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.8

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, on the medically needy route, income over the ABD line means a spend-down, not a denial.3

How Montana Medicaid income limits work: the spend-down

Montana runs an ABD medically needy coverage group: income above the medically needy income level, $525 a month for an individual or a couple, becomes a spend-down obligation, 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; on this route, it does not.

That means Medicaid offers a spend-down: if your income is above the standard, the excess becomes your spend-down obligation. Montana lets you meet it with incurred medical expenses, by paying the spend-down amount to DPHHS in cash, or with a mix of the two. Since January 1, 2026 an extra $391 medically needy income deduction applies, though not to institutional eligibility.3 Once Medicaid is paying for a nursing home, a different calculation takes over: the resident's gross monthly income, less allowable deductions, goes toward the cost of care.3

One question the state manuals we checked don't settle: whether Montana also applies a separate income cap to nursing-home eligibility, and whether an applicant over such a cap would need a Qualified Income Trust, also called a Miller Trust. In states that use one, that cap, the special income level, is set by each state in its own state plan. Federal matching funds for this group are tied to 300% of SSI's $994 individual rate, $2,982 a month in 2026, but a state's published figure does not always match it: Idaho, for example, lists $3,002.9 If your parent's income is near or above $2,982 a month, ask a Montana Office of Public Assistance how it will be treated before you apply, rather than assuming either answer.3

The $2,000 asset limit

Separate from income, Montana applies a countable-resource limit of $2,000 for an aged, blind, or disabled individual and for an unmarried nursing-home resident, and $3,000 for a couple. The general limit for a married applicant entering a nursing home is also $2,000.3 When only one spouse needs care, the community-spouse protections described below apply on top of that. If both spouses need care, ask DPHHS which standard applies to your household.

Only countable resources are subject to the limit. DPHHS's consumer brochure, current only as of January 2017, lists as exempt a house and one car (each "under certain circumstances"), most personal effects and household goods, low-face-value life insurance, burial plots, and a limited burial fund or an irrevocable burial contract, each subject to conditions it doesn't spell out.3 Federal rules separately cap the home equity a long-term-care applicant can hold (see the spousal table below).10 Confirm the current exempt list with an Office of Public Assistance before you move any money.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 ($30 for a resident whose only income is SSI); the federal floor is $30.3,2 The PNA isn't the only money protected: federal rules also deduct a maintenance allowance for a spouse or family at home and unpaid medical costs such as health-insurance premiums before the rest goes to the facility.2 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.3,10 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.10 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's manual uses the 2026 federal figures, printing the $4,066.50 federal maximum allowance as $4,067:3,5,10

A married couple is therefore in a very different position from a single applicant. The community spouse can hold half the couple's countable assets up to $162,660, never less than $32,532, and more if a hearings officer or a court sets a higher amount. She keeps all of her own income while the other spouse receives Medicaid-funded care. Income is shifted from the applicant only to lift her to the $2,705 standard plus any shelter costs above $811.50, and not past $4,067 in total unless a fair hearing finds exceptional financial duress.3,5

After death: estate recovery

Federal law requires every state to seek repayment from the estate of a Medicaid recipient who was 55 or older when they received nursing-facility care, home and community-based services, and related hospital and prescription costs, and a state may choose to recover for more. Recovery waits until a surviving spouse has died, and can't happen while a child under 21 or a blind or permanently and totally disabled child survives. Every state must also offer an undue-hardship waiver.11 DPHHS says Montana's lien and estate recovery law does not affect initial eligibility.3 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:

If you're applying for nursing-home care, ask DPHHS what level-of-care screening is part of the process. Don't rule yourself out because your income is over $525 a month: on the medically needy route, the excess becomes a spend-down, not a denial.3

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, for someone who is financially eligible for Medicaid and meets nursing-facility level of care; it currently has a waiting list.12

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.