How to Apply for Montana Medicaid 2026: Step-by-Step

If your income is over the limit or a parent just entered a nursing home, here is how to apply for Montana Medicaid: file online at apply.mt.gov, by phone, or at a local Office of Public Assistance. Montana uses spend-down, not a Miller Trust, so income above the limit does not bar you.1

In This Guide

• How to Apply for Montana Medicaid
• How Montana's Spend-Down Works
• Before You Apply: Asset Check
• What Documents You'll Need
• How Long It Takes and What Happens Next
• Applying as a Nursing Facility Resident
• Can Someone Else Apply on Your Behalf?
• If You're Denied: How to Appeal
• Where to Get Help
• Frequently Asked Questions
• Learn More

How to Apply for Montana Medicaid

The Montana Department of Public Health and Human Services (DPHHS) administers the state's Medicaid program, including its long-term-care coverage, through three application channels: online, by phone, and in person. All three feed the same eligibility determination, which checks your income against the medically needy spend-down rules and your countable assets against the $2,000 limit for a single applicant.1 Gathering your documents before you start is the single most effective way to avoid delays. Work through the steps below.

How Montana's Spend-Down Works (No Miller Trust Needed)

Montana is a medically needy state. That is a meaningful difference from income-cap states like Texas or South Dakota.1

In an income-cap state, an applicant whose gross monthly income exceeds the cap is ineligible for long-term-care Medicaid unless they establish a Miller Trust (Qualified Income Trust) to redirect the excess. Montana does not require this. Instead, it sets an Aged, Blind and Disabled medically needy income level (MNIL) of $525/month for an individual ($525 for a couple), and lets applicants over that standard "spend down" excess income on incurred medical and care costs to qualify.1

Spend-down works like a deductible: the gap between your countable monthly income and the $525 standard is the amount you must show in qualifying medical expenses before Medicaid pays. DPHHS reviews those expenses as part of the eligibility determination. Effective January 1, 2026, an additional $391 medically needy income deduction applies when DPHHS calculates the spend-down amount, though that deduction does not apply to institutional (nursing-facility) eligibility.1

Qualifying spend-down expenses include nursing home or assisted living bills, prescription drug costs not covered by another payer, Medicare premiums and cost-sharing, physician and specialist visits, and medical equipment and supplies. Keep receipts and billing statements; DPHHS asks for documentation. If you work with an elder law attorney, ask them to confirm your monthly spend-down amount before you apply so the calculation is right the first time.

Before You Apply for Montana Medicaid: Asset Check

DPHHS reviews your countable assets before approving long-term-care Medicaid. The single-applicant resource limit is $2,000 ($3,000 for a couple; the resource standard for an institutionalized individual is also $2,000).1

Exempt assets, which do not count, include the primary home up to the federal home-equity limit, one vehicle, household goods and personal property, and a prepaid burial plan.5 Countable assets, which do count, include checking and savings accounts, certificates of deposit, stocks and bonds, non-retirement investment accounts, the cash value of life insurance above any exempt threshold, and most retirement accounts depending on payout status.

For 2026, the Medicaid home-equity limit for long-term-care eligibility starts at a federal minimum of $752,000, indexed annually; Montana applies the federal minimum standard.5 A primary residence with equity above the applicable limit can disqualify an applicant from nursing-facility coverage, with statutory exceptions when a spouse or dependent lives in the home.

If your countable assets exceed $2,000, you spend them down before qualifying.1 Work with an elder law attorney to avoid transfers that could trigger the 60-month look-back penalty.2

The 60-month look-back. Montana reviews the prior 60 months of financial transactions for any gifts or below-market transfers.2 Transfers made for less than fair market value during the look-back trigger a penalty period during which Medicaid will not pay for nursing-facility services. The length of the penalty depends on the amount transferred divided by the average monthly private-pay cost of nursing care in Montana.2

For married couples, spousal protections apply. The community spouse (the spouse not entering the nursing facility) may keep up to $162,660 in countable assets (minimum $32,532) under the Community Spouse Resource Allowance, and may receive a Minimum Monthly Maintenance Needs Allowance in the federal range of $2,705.00 to $4,066.50 per month from the institutionalized spouse's income.1

What Documents You'll Need

Gather these before you start. Incomplete applications slow processing.

Identity and citizenship:

• Social Security card or statement
• Birth certificate, U.S. passport, or other citizenship documentation
• Montana driver's license or state ID

Income:

• Social Security award letter or SSA-1099
• Pension and retirement benefit statements
• Any other monthly income documentation

Assets and financial accounts:

• Bank statements for all accounts (at minimum the past 3 months; for nursing home applications, prepare up to 60 months)
• Statements for retirement accounts, certificates of deposit, stocks, and bonds
• Life insurance policy documentation (face value and cash surrender value)
• Prepaid burial or funeral contract documentation

Property:

• Property deed and recent tax assessment
• Vehicle registration or title

Medical expenses (for the spend-down calculation):

• Medical bills from recent months
• Medicare premium and supplement statements
• Pharmacy receipts

For nursing home or home- and community-based services (HCBS) waiver applications, prepare five years of bank statements. DPHHS reviews the full 60-month look-back for these applications.2

How Long It Takes and What Happens After You Apply

Federal law caps how long the state may take. Under 42 CFR 435.912, DPHHS must determine eligibility within 45 calendar days for most applicants and within 90 calendar days for applicants who apply on the basis of disability.3 Montana follows this federal timeliness standard. The 45-day and 90-day figures are the maximum periods, measured from the date of application; long-term-care determinations often run toward the longer end because the financial review and any clinical assessment take time. The most common cause of delay is missing documents, so respond to any DPHHS request quickly.

After DPHHS receives a complete application, one of three things happens:

• If approved, you receive a Medicaid card and an eligibility notice. Coverage can be backdated: federal law requires retroactive eligibility for covered services furnished in or after the third month before the month you apply, if you would have been eligible then.4 (For applications filed on or after January 1, 2027, a federal law change shortens that window to two months before the application month for most enrollees, and one month for the Medicaid expansion adult group.)4
• If DPHHS requests more documents, respond by the deadline in the notice. Missing that deadline is one of the most common reasons applications are denied or delayed.
• If denied, you have the right to appeal (see below).

Check your status online at apply.mt.gov if you applied online, or call 1-888-706-1535 for an update.

Applying as a Nursing Facility Resident

If a family member recently entered a nursing facility and Medicaid is not yet approved, applying now limits out-of-pocket exposure, because retroactive coverage can reach back up to three months.4 You can still apply after a relative has moved in; facility social workers often assist with applications and coordinate with DPHHS on your behalf.

Once Medicaid is approved, the resident keeps a Personal Needs Allowance of $50/month from their income; the rest goes toward the cost of care, with Medicaid covering the difference.1 If a community spouse is living at home, DPHHS calculates how much of the institutionalized spouse's income the community spouse may keep (the Minimum Monthly Maintenance Needs Allowance). Any amount above that contribution goes toward the cost of the facility.

Can Someone Else Apply on Your Behalf?

Yes. A family member, friend, or legal representative can apply for you.

• A close family member with knowledge of the applicant's finances can typically sign the application directly.
• Someone outside the family who is not a legal representative needs a signed authorization form from the applicant.
• A person with legal authority (power of attorney, legal guardian, or court-appointed conservator) can sign and act as the applicant's representative by providing documentation of that authority.

Once authorized, a representative can submit the application, provide documents, communicate with DPHHS, and receive notices on the applicant's behalf.

If You're Denied: How to Appeal

Montana applicants who are denied have the right to a fair hearing. Under federal rule 42 CFR 431.221(d), a state Medicaid agency must allow at least 90 days from the date the denial notice is mailed to request a hearing.6 Your denial notice states the reason for the denial and the deadline to appeal, so read it carefully and act before that date.

To request a hearing, you can:

• Call 1-888-706-1535 and ask to request a fair hearing.
• Write a request and mail it to your local OPA office.
• Ask OPA staff in person to initiate a hearing request.

During the hearing, an independent hearing officer reviews the case. You can present documents and explain your situation. Having an elder law attorney or a legal aid representative present is often helpful for complex cases. Free legal help is listed in the resources below.

Where to Get Help

Use these Montana and federal resources to start your application, check your status, ask questions, or get free legal help with a denial.

Learn More

Find personalized help applying for Montana Medicaid 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.