To apply for Montana Medicaid, you can file online, by phone at 1-888-706-1535, or at a local Office of Public Assistance. Montana uses spend-down rather than a Miller Trust to handle income above the medically needy limit.
For current program details, visit the Montana Department of Public Health and Human Services.
How to Apply for Montana Medicaid
Montana's Department of Public Health and Human Services (DPHHS) administers Medicaid long-term care through three application channels.
Online at apply.mt.gov
Go to apply.mt.gov to submit your application online. The portal allows you to complete the application, upload supporting documents, and track your status after submission. Creating an account is optional but recommended if you want to save your progress and receive status updates.
Have your documents ready before you start (see the documents section below). The portal is available around the clock, so you can complete it in stages if needed.
By Phone
Call the Montana Public Assistance Helpline at 1-888-706-1535. A representative will walk you through the application questions. This option works well for applicants who have difficulty with online forms or prefer to speak with someone directly.
If you are deaf, hard of hearing, or speech-impaired, use Montana Relay at 711 before dialing.
In Person at an Office of Public Assistance
Walk into any local Office of Public Assistance (OPA). Staff can help you complete the application and make sure you have the right documents. Find your nearest OPA through the DPHHS website at dphhs.mt.gov/MontanaHealthcarePrograms.
In-person visits are useful when your financial picture is complex, when you're dealing with a recent transfer of assets, or when you need to explain a spend-down situation in detail.
Not sure if you qualify? Chat with Brevy's care navigator at brevy.com to check your eligibility before you apply.
How Montana's Spend-Down Works (No Miller Trust Needed)
Montana is a medically needy state. This is a significant difference from income-cap states like Texas or South Dakota.
In an income-cap state, if your gross monthly income exceeds $2,982, you are flatly ineligible for long-term care Medicaid unless you establish a Miller Trust (Qualified Income Trust) to redirect the excess. Montana does not require this. Instead, it lets applicants "spend down" excess income on incurred medical and care costs to reach the medically needy income standard.
In practice: if your monthly income is $3,400 and Montana's medically needy standard is, say, $2,200, you can apply once you accumulate $1,200 in qualifying medical expenses for the month. Those expenses are documented and deducted from your income for Medicaid eligibility purposes. DPHHS reviews these expenses as part of the eligibility determination.
Common qualifying spend-down expenses include:
- Nursing home or assisted living bills
- Prescription drug costs not covered by another payer
- Medicare premiums, deductibles, and copays
- Physician and specialist visits
- Medical equipment and supplies
Keep receipts and billing statements. DPHHS will ask for documentation.
If you receive help from an elder law attorney, ask them to confirm your monthly spend-down amount before you apply. Getting this calculation right the first time avoids delays.
Before You Apply for Montana Medicaid: Asset Check
DPHHS will review your countable assets before approving long-term care Medicaid. The single-applicant limit is $2,000 ($4,000 for a married couple with both spouses applying).
Exempt assets (not counted):
- The primary home, up to $752,000 in equity
- One vehicle
- Household goods and personal property
- Prepaid burial plans
Countable assets (do count):
- Checking and savings accounts
- Certificates of deposit (CDs)
- Stocks, bonds, and non-retirement investment accounts
- Cash value of life insurance above any exempt threshold
- Most retirement accounts, depending on payout status
If your countable assets exceed $2,000, you will need to spend them down before qualifying. Work with an elder law attorney to avoid transfers that could trigger the 60-month look-back penalty.
The 60-month look-back. Montana reviews the prior 60 months of financial transactions for any gifts or below-market transfers. Transfers made to reduce assets for Medicaid eligibility create a penalty period during which Medicaid will not pay for nursing facility services. The length of the penalty depends on the amount transferred and the average monthly private-pay cost of nursing care in Montana.
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 (MMMNA) of $2,643.75 to $4,066.50 per month from the institutionalized spouse's income.
What Documents You'll Need
Gather these before you start. Incomplete applications slow down 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, CDs, 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 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.
What Happens After You Apply for Montana Medicaid
Once you submit, DPHHS will review your application and may contact you for additional documents or a phone interview. Processing timelines vary, but state and federal rules require a timely decision.
After DPHHS receives a complete application:
- If approved, you will receive a Medicaid card and an eligibility notice. Coverage may be backdated to the first day of the month you applied, depending on the program.
- If DPHHS requests more documents, respond quickly. A request for additional information will specify a deadline. Missing that deadline is one of the most common reasons applications are denied or delayed.
- If denied, you have the right to appeal.
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 is already in a nursing facility, you can still apply for Medicaid to cover care going forward. Facility social workers often assist with applications and can 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.
If a community spouse is living at home, DPHHS will calculate how much of the institutionalized spouse's income the community spouse may keep (the MMMNA). Any amount above that contribution goes toward the nursing home cost.
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. The denial notice will state the reason for the denial and the deadline to appeal. Generally, you must request a hearing within a set number of days from the date of the notice.
To request a hearing:
- Call 1-888-706-1535 and ask to request a fair hearing.
- Write a request and mail it to your local OPA office.
- Ask the 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.
Montana Legal Services Association (MLSA) offers free legal assistance to low-income Montanans. Contact MLSA at montanalegalservices.org or call 1-800-666-6899.
Questions about your denial? Talk to Brevy's care navigator at brevy.com for guidance on next steps.
Frequently Asked Questions
No. Montana is a medically needy state. Applicants with income above the medically needy standard qualify by spending down excess income on incurred medical and care expenses. A Miller Trust (Qualified Income Trust) is not required and is not part of Montana's Medicaid program.
Montana does not use a fixed income cap for long-term care Medicaid. Instead, it applies a medically needy income standard, and applicants with income above that standard qualify by documenting and deducting qualifying medical expenses (spend-down). There is no single income ceiling that bars you from applying.
Montana applies a 60-month (5-year) look-back to any transfers of assets made for less than fair market value. Gifts, below-market sales, and transfers to trusts within that window can trigger a penalty period. The look-back applies to nursing facility and HCBS waiver applications.
Generally, yes. The primary home is an exempt asset while the community spouse lives there, subject to a home equity cap of $752,000 (2026). After the death of the Medicaid recipient, Montana may pursue estate recovery on the value of the home. Talk to an elder law attorney about steps that can minimize or defer recovery.
Federal and state rules require DPHHS to process Medicaid applications within a set timeframe. Delays most often result from missing documents. Submit a complete package and respond to any DPHHS requests promptly. If you applied at apply.mt.gov, check your status there. Otherwise, call 1-888-706-1535 for an update.
Report income changes to DPHHS promptly. Montana requires Medicaid recipients to report changes in income, assets, or household composition. Changes can affect your spend-down amount or your overall eligibility. Failure to report changes can result in an overpayment and a repayment obligation.
Learn More
- Montana Medicaid Eligibility and Income Limits
- Medicaid Planning Strategies
- Medicaid Estate Recovery Explained
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.