If your income is over the limit or a parent just entered a nursing home, here is how to apply for Montana Medicaid: online, by phone, by mail, or in person. File at apply.mt.gov, call the Public Assistance Helpline, or go to any Montana Office of Public Assistance. Federal rule requires the state to take a mailed application too. Montana runs a medically needy spend-down, so income above its $525 monthly standard does not by itself rule you out.

In This Guide

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 four application channels: online, by phone, in person, and by mail., All four 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. Gathering your documents before you start is one of the simplest ways to avoid delays. Work through the steps below.

1
Step 1

Gather your documents first

Before you begin, collect identity and citizenship proof, income statements, and bank and asset records for everyone applying (see the documents section below). Missing paperwork is a frequent reason an application stalls, so having it ready keeps the fastest channel fast.

2
Step 2

Choose a channel and submit your application

Apply online at apply.mt.gov, by phone through the Montana Public Assistance Helpline at 1-888-706-1535, or in person at any Montana Office of Public Assistance (OPA). Phone and in-person help suit applicants with complex finances, a recent asset transfer, or a spend-down situation to explain, since staff can walk you through the forms. You can also apply by mail, a channel federal rule requires the state to accept and the one that matters when you can neither get online nor travel to an office; ask the helpline or a local OPA for the paper form and the address to send it to. Federal rule also requires the state to accept electronic signatures, including ones recorded over the phone, so applying online or by phone doesn't mean a trip to sign paper.

3
Step 3

Complete the financial review and any long-term-care assessment

DPHHS reviews your income, assets, and, for long-term care, your spend-down expenses. Applicants for the Big Sky Waiver, Montana's main home- and community-based waiver, must also meet the minimum level-of-care requirements for nursing facility placement, a clinical question separate from the financial one, and must have an unmet need that only Big Sky Waiver services can resolve. DPHHS says the program currently has waiting lists, so apply early.

4
Step 4

Respond promptly to any request for more information

If DPHHS needs additional documentation, answer quickly. Federal rule counts an applicant's own delay among the unusual circumstances that can excuse the agency from its decision deadline, so a slow answer stretches your wait.

How Montana's Spend-Down Works

Montana runs an Aged, Blind and Disabled medically needy coverage group, and that shapes how income is handled for long-term care.

CMS says most states have adopted a special income level for long-term care set at 300% of the SSI federal benefit rate, which is $2,982 a month in 2026. MACPAC's 2025 state-by-state table of eligibility levels for older adults and people with disabilities shows Montana does not use that special income level pathway. Montana's own Medicaid manuals don't say whether it imposes an income cap or requires a Miller Trust (Qualified Income Trust), so confirm with an Office of Public Assistance before you set one up or decide to skip one.

What the manuals do set is a medically needy income level (MNIL) of $525/month for an individual ($525 for a couple). An applicant over that standard meets a spend-down obligation by using incurred medical expenses, by paying the spend-down amount to the department in cash, or by a combination of the two.

Spend-down works like a deductible: the gap between your countable monthly income and the $525 standard is the amount you must cover, with medical bills, a cash payment, or both, 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.

Gather bills for the care and medical costs you're paying, such as nursing home charges, prescriptions, doctor visits, and Medicare premiums, and ask your Office of Public Assistance which ones DPHHS will count. 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).

Montana's limit is a countable-resource standard: the equity value of everything you own counts unless a regulation excludes it, and Montana excludes the home and the land around it. Only one home is excluded, your principal place of residence, and a home outside Montana counts. The exclusion holds as long as you, or your spouse, power of attorney, guardian or authorized representative, state your intent to return there. Separately, Montana won't pay for nursing home or waiver care when your home equity is over $752,000 (effective January 1, 2026), whatever your intent to return, unless a spouse or a minor or disabled child lawfully lives in the home. DPHHS's consumer brochure, which it marks current only as of January 2017, also lists most personal effects and household goods, one car, low-face-value life insurance, burial plots, and a limited burial fund or an irrevocable burial contract as exempt, each under conditions it doesn't spell out. Confirm the current list, and how any account or policy you're unsure of is treated, with your Office of Public Assistance.

For 2026, the Medicaid home-equity limit for long-term-care eligibility is $752,000 unless the state elects a higher amount, up to $1,130,000, and both figures are indexed annually. Beginning January 1, 2028, a 2025 federal law (the One Big Beautiful Bill Act, Public Law 119-21) will cap that figure at $1,000,000 for any home not on a lot zoned for agricultural use, so the limit will stop rising with inflation once it reaches that ceiling. Equity above the limit can bar long-term-care coverage, but the test doesn't apply at all while a spouse, a child under 21, or a blind or permanently and totally disabled child lawfully lives in the home. Equity can also be brought under the limit with a reverse mortgage or home equity loan, and federal law requires a hardship waiver process.

If your countable assets exceed $2,000, you 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 looks back 60 months from the date a nursing-facility or waiver applicant applies, checking for gifts or below-market transfers., A transfer for less than fair market value in that window triggers a penalty period during which Medicaid won't pay for nursing-facility care or home and community-based waiver services; the rest of your Medicaid coverage isn't withdrawn. The penalty's length is the total uncompensated value transferred divided by the state's average monthly private-pay cost of nursing-facility care. Some transfers are exempt, including any transfer to your spouse, and a penalty can be waived for undue hardship.

For married couples, spousal protections apply. The community spouse (the spouse not entering the nursing facility) keeps the greatest of four amounts: half the couple's combined countable assets, capped at $162,660; a $32,532 minimum; an amount a hearings officer designates; or a court-ordered amount. Only the half-of-assets route carries the cap, so a hearing or a court order can leave the community spouse more. On the income side, the spouse in the facility can send part of their income home as a community spouse income maintenance allowance, but only if the money is actually transferred. Montana's manual sets it at the lesser of $4,067 minus the community spouse's own gross monthly income, or the $2,705 basic needs standard plus shelter costs above $811.50, minus that same income. Those figures size the allowance; they don't cap the community spouse's own income, and a fair hearing showing significant financial duress from exceptional circumstances, or a court support order, can raise it. For the full picture, see Montana Medicaid Eligibility and Income Limits.

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 (for nursing home and waiver 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.

How Long It Takes and What Happens After You Apply

Federal law caps how long the state may take. Under 42 CFR 435.912, a DPHHS eligibility determination may not exceed 45 days for most applicants or 90 days for people who apply for Medicaid on the basis of disability. Montana must also set its own timeliness standards in its State plan and tell applicants what they are. Which limit applies turns on the basis the application was filed under, not on whether a disability determination happens to arise, so an older adult applying for long-term-care coverage on the basis of age is on the 45-day standard even when medical records are part of the file. The 45-day and 90-day figures are outer limits on the agency measured from the date of application, not a guarantee that a decision arrives by then; long-term-care determinations often run toward the longer end because the financial review and any clinical assessment take time. An applicant's own delay is one of the circumstances that can excuse the agency from the limit, though the agency may not use the limit as a reason to deny you, 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. (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.)
  • If DPHHS requests more documents, respond by the deadline in the notice. Missing that deadline can hold up your case or lead to a denial.
  • If denied, you have the right to appeal (see below).

For questions about your application, call the Public Assistance Helpline at 1-888-706-1535, the same line that takes applications by phone.

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. 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 contributing to the cost of care, the resident's gross monthly income, less allowable deductions, goes toward that cost, and one of those deductions is a Personal Needs Allowance of $50/month the resident keeps. If a community spouse is living at home, another deduction is the maintenance allowance described above, sent home to that spouse, allowed only if the money is actually transferred. Whatever income is left goes toward the cost of the facility.

Can Someone Else Apply on Your Behalf?

Yes. Federal rule requires the state to accept an application from the applicant, from an adult in the applicant's household or family, from an authorized representative, or, if the applicant is incapacitated, from someone acting responsibly for them.

  • Every initial application must be signed under penalty of perjury, and electronic and phone-recorded signatures count.
  • If you're helping a parent apply and aren't applying yourself, giving your own Social Security number is voluntary.
  • If you hold a power of attorney or guardianship, bring a copy, and ask the Office of Public Assistance what it needs to treat you as the applicant's representative.

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 give a reasonable time to request one, and that window may not exceed 90 days from the date the denial notice is mailed. Ninety days is the outer limit a state may allow, not a guarantee. Montana uses the full 90 days for most notices, but a hearing request about how much a nursing-home resident must pay toward the cost of care must be received within 30 days of the notice mailing. Both deadlines count from the date the notice is mailed, so send your request promptly rather than waiting until the last week.

Montana's Medicaid manual says the hearing request must be in writing and must reach the Department by the deadline; your signature isn't required. Fair-hearing instructions are printed on the back of every adverse-action notice, so follow them. Hearings are run by the DPHHS Office of Administrative Hearings, which you can reach at (406) 444-2470, hhsofh@mt.gov, or PO Box 202922, Helena MT 59620. You can also ask first for an Administrative Review, a meeting with Fair Hearing Unit staff, without giving up your right to a hearing.

At the hearing 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, ask questions, or get free legal help with a denial.

Montana Department of Public Health and Human Services (DPHHS) Administers Montana Medicaid; its Public Assistance Helpline takes applications by phone. 1-888-706-1535 dphhs.mt.gov/MontanaHealthcarePrograms
apply.mt.gov Montana's online portal for applying for Medicaid. apply.mt.gov
Montana Legal Services Association (MLSA) Free legal assistance to low-income Montanans, including help appealing a Medicaid denial. www.mtlsa.org
Medicaid.gov Federal overview of Medicaid eligibility, benefits, and enrollee rights. www.medicaid.gov
Social Security Administration Verifies Social Security numbers and provides the award letters used as proof of income. 1-800-772-1213https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare www.ssa.gov

Frequently Asked Questions

Does Montana require a Miller Trust to apply for long-term care Medicaid?

Montana's Medicaid manuals don't address it directly. What they set is a medically needy spend-down: an applicant with income above the $525/month medically needy income level can meet the gap with incurred medical expenses, a cash payment to the department, or both. MACPAC's 2025 eligibility table shows Montana doesn't use the long-term-care special income level pathway built on 300% of the SSI benefit rate. Confirm with an Office of Public Assistance before you set up a Miller Trust (Qualified Income Trust) or decide you don't need one.

What is the income limit to apply for Montana Medicaid long-term care?

CMS says most states have adopted a long-term-care special income level of 300% of the SSI benefit rate ($2,982 a month in 2026), but MACPAC's 2025 eligibility table shows Montana doesn't use that pathway. Montana sets an Aged, Blind and Disabled medically needy income level of $525/month for an individual, and an applicant above it can qualify by meeting a spend-down with medical bills, a cash payment to the department, or both. Ask your Office of Public Assistance to confirm how your income will be counted.

How far back does Montana look at my financial history?

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 waiver applications.

Can my spouse keep the house if I go into a nursing home?

Generally, yes. Montana excludes one principal home in Montana from countable assets. The federal home-equity limit doesn't apply at all while your spouse lawfully lives there, and its dollar amounts are indexed annually. Without a spouse or a minor or disabled child living in the home, Montana won't pay for nursing home or waiver care when your equity is over $752,000 in 2026. That indexing won't run forever: beginning January 1, 2028, federal law will hold the limit at no more than $1,000,000 unless the home sits on a lot zoned for agricultural use. Estate recovery is postponed, not cancelled: Montana can't recover from the estate while a surviving spouse is alive, but it can after the spouse dies. Talk to an elder law attorney about steps that can minimize or defer recovery.

How long will it take to get a decision on my application?

Federal rule 42 CFR 435.912 caps DPHHS at 45 days for most applicants and 90 days for people who apply for Medicaid on the basis of disability. Which cap applies depends on the basis you applied under, not on whether a disability determination arises, so an aged-basis long-term-care application sits on the 45-day standard. Those are limits on the agency rather than a guaranteed decision date, and an applicant's own delay can excuse the agency from them. Submit a complete package and respond to any DPHHS requests promptly. For questions, call the Public Assistance Helpline at 1-888-706-1535.

What if my income changes after I'm approved?

Tell DPHHS promptly. A change in income, assets, or household can change your spend-down amount or your eligibility, and your approval notice or caseworker can tell you what you must report and by when.

Learn More

MedicaidHow to Apply for Medicaid by State: Steps, Documents, and Where to ApplyHow to apply for Medicaid: the ways you can apply, the documents to gather, how long a decision takes, and the application guide for your state. MedicaidMontana Medicaid Eligibility and Income LimitsMontana Medicaid income limits 2026: adults under 65 qualify to 138% FPL with no asset test; seniors and long-term care get a spend-down and a $2,000 limit. MedicaidMontana Medicare Cost-Sharing Help for SeniorsMontana Medicare Savings Programs 2026: QMB, SLMB, and QI income limits, what each pays, Part D Extra Help, and how to apply through Montana DPHHS. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. MedicaidMedicaid Estate Recovery ExplainedMedicaid estate recovery can claim a home after death, but not while a spouse or a child under 21, blind or disabled survives. See your state's rules.

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.

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