Montana Medicaid Income Limits 2026: Eligibility & Assets

Montana Medicaid income limits work differently than most people fear: being over the line doesn't get you turned away, it puts you on a spend-down. 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 walks through the 2026 income and asset rules for Montana Medicaid long-term care: the spend-down, the $2,000 asset limit, what a nursing-home resident keeps, and what a spouse at home is protected from.

How Montana Medicaid income limits really work: spend-down

Here is the part that trips families up. With Montana Medicaid income limits, being over the medically needy income standard does not disqualify you. Montana is what's called a medically needy state, administered by the Montana Department of Public Health and Human Services (DPHHS).

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, and $4,000 for a married couple when both spouses apply ($2,000 each).

"Countable" is the load-bearing word. Montana, like every state, exempts a long list of assets from the count: your home (subject to an equity cap), 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 the roof over your head.

When only one spouse needs care, the asset picture changes entirely. The spousal-impoverishment rules below let the at-home spouse keep far more, so a married couple is in a very different position from a single applicant.

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.

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. 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.

Protecting 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:

So a married couple is in a very different position from a single applicant. The community spouse can hold up to $162,660 in assets and keep over $4,000 a month in income while the other spouse receives Medicaid-funded care.

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. 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:

1. Online through the state benefits portal at apply.mt.gov, which handles Medicaid, SNAP, and other assistance together.
2. By phone through the Montana Public Assistance Helpline at 1-888-706-1535.
3. In person at a local Office of Public Assistance.

Long-term-care applicants also go through a level-of-care screening to confirm they need nursing-facility-level services. 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.

Learn More

• Medicaid Planning Strategies
• How Medicaid Estate Recovery Works
• The Medicaid Personal Needs Allowance, Explained

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.