Montana Medicaid pays for long-term care for seniors with a $2,000 asset limit and a medically needy spend-down income pathway, so there is no hard income cap and no Miller Trust is required.

Montana Medicaid is administered by the Montana Department of Public Health and Human Services (DPHHS). Montana is a medically needy spend-down state, meaning there is no income cutoff that disqualifies a long-term care applicant and no Qualified Income Trust is required. This guide maps every key question about Montana Medicaid to the dedicated article that answers it.

What Montana Medicaid Covers

Montana Medicaid covers the mandatory federal benefit categories plus a set of state-elected optional services:

  • Hospital care: Inpatient and outpatient services
  • Physician, clinic, and specialist visits
  • Prescription drugs through the DPHHS pharmacy benefit
  • Behavioral health: Mental health and substance use disorder services
  • Home health: Skilled nursing and home health aide services
  • Long-term care: Nursing facility care and Home and Community-Based Services (HCBS) waiver services for people who meet the level-of-care standard
  • Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries
  • Non-emergency medical transportation (NEMT)

For older adults, long-term care is the most financially significant benefit. According to the CareScout 2025 Cost of Care Survey, a semi-private nursing home room runs a national median of about $114,975 per year and a private room about $129,575, with Montana's nursing-home costs running modestly below those national medians and its in-home care at or above them. Once a resident meets both the financial and the clinical tests, Medicaid pays the nursing facility bill that remains after the resident contributes their own income above the protected allowances described below.

Montana Medicaid Eligibility: Who Qualifies for Long-Term Care

Montana Medicaid Eligibility Overview

For seniors seeking nursing facility or HCBS coverage, the 2026 financial parameters are:

  • Asset limit: $2,000 for a single applicant; $3,000 for a couple with both spouses applying. Exempt assets include the primary home (up to the equity cap), one vehicle, household goods, and prepaid burial arrangements.
  • Income approach: Montana is a medically needy spend-down state. The Aged, Blind and Disabled (ABD) medically needy income level is $525 per month for an individual or a couple. An applicant with income above that standard qualifies by spending down excess income on incurred medical and care costs, and a nursing facility resident instead contributes income above protected allowances toward the cost of care. Since January 1, 2026 an additional $391 is deducted from countable income when DPHHS calculates a medically needy spend-down amount, though that deduction does not apply to institutional (nursing facility) eligibility.
  • No Miller Trust required: Because Montana uses a spend-down pathway rather than a 300%-of-SSI income cap, no Qualified Income Trust (Miller Trust) is needed at any income level.
  • Home equity limit: The 2026 federal limit is $752,000 unless the state elects a higher amount, up to $1,130,000. The primary residence is exempt while a spouse or dependent lives there.

For the full income and asset rules, see Montana Medicaid Eligibility & Income Limits.

Montana Medicaid Long-Term Care

Nursing Facility Coverage

Montana Medicaid covers nursing facility care for financially and clinically eligible applicants. The resident contributes income above protected allowances toward the cost of care, keeping a Personal Needs Allowance of $50 per month (the federal floor is $30, and an SSI-only resident keeps $30), plus deductions for health insurance premiums and any community spouse allowance.,

Clinical Eligibility: Nursing Facility Level of Care

Financial eligibility is only half the test. To receive nursing facility or HCBS waiver coverage, an applicant must also meet Montana's clinical "nursing facility level of care" standard. That is a determination that the person needs the kind of ongoing skilled or personal-care assistance a nursing facility provides, based on limitations in daily activities such as bathing, dressing, eating, and mobility, or on cognitive impairment. DPHHS conducts this level-of-care screening as part of the long-term care application.

HCBS Waivers: Care at Home Instead of a Facility

DPHHS administers HCBS waiver programs, chiefly the Big Sky Waiver for older adults and adults with physical disabilities, that fund personal assistance, homemaker services, adult day health, respite, home modifications, a personal emergency response system, private duty nursing, and transportation for seniors who would otherwise need nursing facility care. Waiver eligibility uses the same $2,000 asset limit as institutional Medicaid and requires the same nursing-facility level of care, plus an unmet need that only waiver services can resolve. The Big Sky Waiver currently operates a waiting list. You start the process by making a referral to the state's contractor, Mountain-Pacific Quality Health, at 1-800-219-7035 or 406-443-4020, and have your Medicaid financial eligibility determined by your county Office of Public Assistance.

The 5-Year Lookback and Transfer Penalties

Montana applies a 60-month (five-year) lookback to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers within that window generate a penalty period of Medicaid ineligibility, calculated by dividing the transferred amount by the average monthly private-pay nursing facility cost. An undue-hardship waiver is available where the penalty would deprive the applicant of necessary care.

Estate Recovery

After the death of a recipient who was age 55 or older when they received Medicaid-paid services (or who lived in a nursing home or a state institution at any age), Montana pursues estate recovery. Recovery is not limited to long-term care: it reaches Medicaid payments for nursing facility care, home and community-based services, hospital care, prescription drugs, and other covered services. Adults covered under Medicaid expansion (ages 19 to 65) are subject to recovery only for long-term care services. Montana uses an expanded estate definition, not a probate-only one. Recovery may reach property that passes outside probate, including property held in joint tenancy or tenancy-in-common and property transferred by a beneficiary (transfer-on-death) deed. Recovery is not enforced while there is a surviving spouse (though the state may claim against that spouse's own estate, up to the value of what they received from the recipient, if the spouse dies within three years), a surviving child under age 21, or a surviving child of any age who is blind or permanently and totally disabled, and heirs may apply for an undue-hardship waiver.

See Montana Medicaid Estate Recovery for the full rules and hardship waiver process. To challenge a denial or reduction, see Montana Medicaid Appeals and Fair Hearings.

Montana Medicare Savings Programs

Montana Medicaid administers the federal Medicare Savings Programs (MSPs), which help low-income Medicare beneficiaries pay their Medicare costs. Three of the four are the ones most seniors use:

Program What It Covers 2026 Income Limit (Single)
QMB (Qualified Medicare Beneficiary) Part A and Part B premiums, plus Part A and Part B deductibles, coinsurance, and copays Up to $1,350/month
SLMB (Specified Low-Income Medicare Beneficiary) Part B premium only Over $1,350, up to $1,616/month
QI (Qualifying Individual) Part B premium only, awarded first come, first served from a capped annual federal allotment, and not available to anyone who also has full Medicaid Over $1,616, up to $1,816/month

Federal resource standard for all three: $9,950 for one person, $14,910 for a couple. QI must be applied for again every year.

Enrolling in QMB, SLMB, or QI automatically deems you eligible for Part D Extra Help (the Low-Income Subsidy), eliminating most prescription drug cost-sharing, and federal law bars providers from billing a QMB enrollee for Part A or Part B deductibles, coinsurance, or copayments. The fourth MSP, Qualified Disabled and Working Individual (QDWI), is narrower: it pays the Part A premium for certain working people with disabilities who lost premium-free Part A, allows much higher income ($5,405 a month for one person in 2026) against a much lower $4,000 resource limit, and does not confer Extra Help. The published income figures already include the $20 monthly SSI general income exclusion, and a state may disregard other income and resources alike, so apply through DPHHS or the Social Security Administration even if you look slightly over either line.

See Montana Medicare Savings Programs for full details.

Spousal Impoverishment Protections

When one spouse enters a nursing facility and the other stays in the community, the goal is to keep the at-home spouse from being left without enough to live on. Montana applies federal spousal impoverishment protections to do exactly that.

Key 2026 figures:

  • Community Spouse Resource Allowance (CSRA): The community spouse keeps half of the couple's countable assets, bounded by a 2026 federal minimum of $32,532 and a maximum of $162,660. Half of a modest estate is raised to the minimum, and half of a large one is capped at the maximum. In between, the number that matters is half of what the couple actually holds, not the maximum, so do not assume the $162,660 figure is what your household protects.,
  • Minimum Monthly Maintenance Needs Allowance (MMMNA): The community spouse's income is protected in a federal range of $2,705.00 to $4,066.50 per month; if their own income falls short, a portion of the applicant's income can be diverted to bring them up to the floor.
  • Home: Exempt from the eligibility calculation while the community spouse lives there.

The community spouse's own income is protected entirely under the "name on the check" rule: only the applicant's income flows toward the nursing facility cost. See Montana Medicaid Spousal Impoverishment Protections for the snapshot process.

How to Apply for Montana Medicaid

Applying for Montana long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the three agency pathways.

1
Step 1

Gather your documents

Collect income statements, asset and bank records covering the full 60-month lookback period, proof of identity and Montana residency, your Social Security card, insurance cards, and any trust, annuity, or life-estate paperwork. Missing records are the most common cause of delay.

2
Step 2

Submit the application

Apply online through the Montana benefits portal at apply.mt.gov, call the Montana Public Assistance Helpline at 1-888-706-1535, or apply in person at a local Office of Public Assistance.

3
Step 3

Complete the level-of-care assessment

Long-term care applicants receive a clinical nursing-facility level-of-care screening in addition to the financial review, determining whether the applicant qualifies for institutional or HCBS waiver coverage.

4
Step 4

Respond to any requests and await the decision

The agency may ask for additional verification. Federal rules give the agency up to 45 calendar days to decide, or up to 90 calendar days for applications based on disability, measured from the date you apply to the date the agency notifies you of its decision, so reply promptly and watch for the written eligibility determination.

5
Step 5

Appeal in writing if you disagree

Montana allows the full federal window for most decisions: DPHHS must receive your written fair hearing request within 90 days of the date your adverse-action notice was mailed, and your signature is not required. The trigger is the payload here, not the number. The 90 days in 42 CFR 431.221(d) is only the ceiling on what a state may allow, and your clock started the day DPHHS put the notice in the mail, not the day you opened it. One long-term-care decision runs far shorter: a request disputing DPHHS's determination of your ability to pay for the cost of institutional (nursing-home) care must reach DPHHS within 30 days of the notice mailing.

Keeping benefits you already have runs on an earlier clock than filing. If DPHHS receives your request between the date the adverse-action notice was mailed and the date the action takes effect, your benefits are automatically continued at the same level until the hearing decision, unless you say you do not want them. If the Department failed to send timely advance notice, benefits continue only when you file within 10 days of receiving the notice, and the notice is presumed received 5 days after mailing. Continuation is not free: if the hearing decision favors the Department, you must repay the benefits you received during the appeal.

See How to Apply for Montana Medicaid for a step-by-step walkthrough.

Keeping Montana Medicaid Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency rather than on you. Before it asks you for anything, Montana Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot. If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Montana may offer the same windows but is not required to, so ask DPHHS what applies to you.

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise). So a MAGI-based renewal missed by a few weeks is usually recoverable, provided you act.

Return a renewal form the week it arrives. See Montana Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Montana DPHHS Healthcare Programs Administers Medicaid eligibility, long-term care, and Medicare Savings Programs; takes applications and answers program questions. 1-888-706-1535 dphhs.mt.gov/MontanaHealthcarePrograms
Montana Benefits Portal (apply.mt.gov) File a Montana Medicaid application online, including for aged, blind, and disabled long-term care coverage. apply.mt.gov
Montana DPHHS Senior and Long Term Care Point of contact for HCBS waiver access, level-of-care assessments, and the Aging and Disability Resource Centers that help seniors arrange care at home. dphhs.mt.gov/sltc

Montana Medicaid FAQ

Frequently Asked Questions

Does Montana Medicaid require a Miller Trust?

No. Montana is a medically needy spend-down state. There is no hard income cap for long-term care Medicaid, so a Qualified Income Trust (Miller Trust) is not required at any income level. An applicant with income above the $525 medically needy standard qualifies by spending down excess income on incurred medical and care costs, or, in a nursing facility, by contributing income above protected allowances as patient liability toward the cost of care.

What is the asset limit for Montana Medicaid long-term care?

$2,000 for a single applicant, or $3,000 for a couple with both spouses applying. Exempt assets include the primary home, one vehicle, household goods, and prepaid burial arrangements. The home exemption is subject to the 2026 federal equity limit of $752,000 unless the state elects a higher amount. Cash, bank accounts, and non-exempt investments all count.

How much can a nursing facility resident keep each month?

$50 per month as a Personal Needs Allowance (an SSI-only resident keeps $30, the federal floor). Income above that, minus deductions for health insurance premiums and any community spouse allowance, is applied as patient liability toward the cost of nursing facility care.

Will Montana Medicaid recover from my estate?

Montana pursues estate recovery against recipients who were age 55 or older when they received Medicaid-paid services, and against nursing home and state-institution residents of any age. Recovery is not limited to long-term care bills; it covers other Medicaid-paid services too, except for adults covered under Medicaid expansion, who are subject to recovery only for long-term care. Montana uses an expanded estate definition that can reach property passing outside probate (including jointly held property and transfer-on-death deeds), not just probate assets. Recovery is deferred while a surviving spouse, a child under 21, or a blind or disabled child of any age survives, and an undue-hardship waiver is available. See Montana Medicaid Estate Recovery.

What documents do I need to apply for Montana Medicaid?

Gather proof of identity (state ID or birth certificate), proof of Montana residency, your Social Security card, income documentation (Social Security award letters, pension or retirement statements), asset statements (bank and investment accounts), and five years of financial records. Long-term care applicants should also have any trust documents, annuity contracts, or life-estate deeds available.

Learn More

MedicaidMedicaid by State: Eligibility, Coverage, and How to ApplyMedicaid works differently in every state, from who qualifies to what's covered and how to apply. See what varies and jump to your state's full guide. MedicaidMontana Medicaid Eligibility & 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. MedicaidHow to Apply for Montana MedicaidApply for Montana Medicaid online, by phone, by mail, or in person. Covers spend-down with no Miller Trust, documents, timelines, and how to appeal a denial. MedicaidMontana Medicaid Estate RecoveryMontana DPHHS can claim a deceased Medicaid recipient's home or farm, even property in joint tenancy or a beneficiary deed. See who is exempt from recovery. MedicaidMontana Medicare Savings ProgramsMontana Medicare Savings Programs 2026: QMB, SLMB, and QI income limits, what each pays, Part D Extra Help, and how to apply through Montana DPHHS. MedicaidMontana Medicaid Spousal Impoverishment ProtectionsMontana Medicaid spousal impoverishment rules in 2026: a CSRA of $32,532–$162,660, an MMMNA income floor of $2,705.00, and Montana's spend-down pathway. 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 explained: federal law, 51-state matrix, categorical protections, hardship waivers, and 2025-2026 reform updates. Verify before acting.

Find personalized help understanding Montana Medicaid long-term care eligibility 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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