Montana Medicaid Recertification and Renewal (2026)

Ignoring a renewal packet from Montana Medicaid can end your coverage even if you still qualify. Federal law (42 CFR 435.916) requires the state to try to renew your coverage automatically from data it already holds before it asks you for a single document, but once a packet does reach you, it has to come back on time. This guide explains how the Montana Medicaid recertification and renewal cycle works, what to do when your packet arrives, and the 90-day window to recover if you miss the deadline.

Renew or update your case at apply.mt.gov · Montana Public Assistance Helpline: 1-888-706-1535

Recertification and renewal is the moment a Montana Medicaid case is most likely to close by accident. Eligibility is set once at initial application, but under 42 CFR 435.916 it is redetermined at least every 12 months thereafter.1

Montana runs its Medicaid program through the Department of Public Health and Human Services (DPHHS), with eligibility casework handled at local Offices of Public Assistance. Unlike states that contract with risk-based health plans, Montana delivers Medicaid on a fee-for-service basis coordinated through Passport to Health, its primary care case management program.4

In This Guide

• How the recertification and renewal cycle works
• Ex parte renewal: what Montana checks first
• How to renew Montana Medicaid
• The 90-day reconsideration window
• Children, pregnancy, and postpartum coverage
• Long-term care and Big Sky Waiver renewals
• When your mail is returned
• Appealing a termination
• What is changing after 2026
• Common mistakes
• Frequently Asked Questions
• Learn More

How the Montana Medicaid recertification and renewal cycle works

Under 42 CFR 435.916, DPHHS must redetermine eligibility at least every 12 months. That yearly review is a minimum, not a ceiling: for coverage based on age, blindness, disability, or long-term care the state may redetermine more often.1 Your renewal month is set at approval and stays the same each year.

Renewals split into two procedural paths depending on eligibility category:

• MAGI populations (children in Healthy Montana Kids Plus, pregnant women, parents and caretaker relatives, and expansion adults ages 19 to 64) are renewed using Modified Adjusted Gross Income methodology. In Montana the monthly income cutoffs run to 143% of the federal poverty level for children, 157% for pregnant women, 24% for parents and caretaker relatives, and a 133% base standard (about 138% after the standard 5%-of-FPL disregard) for expansion adults.5
• Non-MAGI populations (aged, blind, and disabled beneficiaries, nursing-facility and Big Sky Waiver participants, Medicare Savings Program enrollees, and the medically needy) are renewed under rules that include an asset test. Montana keeps the aged, blind, and disabled countable-resource limit at $2,000 for an individual and $3,000 for a couple.3 Federal law (Section 1940 of the Social Security Act) requires the state to verify those assets at every renewal through an Asset Verification System, so non-MAGI renewals usually require the beneficiary to submit bank statements, retirement and life-insurance documentation, and a signed verification authorization.6

Montana operates an aged, blind and disabled medically needy coverage group, so income above the medically needy standard is spent down on incurred medical and care costs rather than ending coverage at renewal. Ask DPHHS whether any separate long-term-care income limit applies to your case.3

Ex parte renewal: what Montana checks first

Before DPHHS asks you for any information at renewal, 42 CFR 435.916(a)(2) requires it to redetermine your eligibility from reliable information already in your account and from electronic data sources it can access; on the aged, blind, disabled and long-term-care pathways, paragraph (b) imposes that duty whenever sufficient information is available. Only when it cannot renew you on that basis may it request information from you.1

In practice DPHHS runs your case against wage, Social Security, tax, and other benefit data available to it. If those sources confirm you remain within the income standard for your eligibility category and that household composition has not changed, the renewal processes automatically. You get a notice of the decision and the basis for it. You do not have to sign and return it, but you do have to report anything on it that is wrong.1

Ex parte often cannot finish the job for these reasons:

• An asset test that automated data cannot clear. Aged, blind, disabled, and long-term-care renewals require asset documentation, so DPHHS has to request what the data sources do not supply.6
• Income that does not appear in wage databases, such as self-employment, seasonal ranch and construction work, or cash income.
• Household changes like a new baby, a spouse moving out, marriage, or divorce, all of which need documentation.

When ex parte fails, DPHHS has to come back to you for what is missing. If your eligibility is based on MAGI, federal law requires DPHHS to send a renewal form containing the information it already has and to give you at least 30 days from the date of the renewal form to respond, supply any missing information, and sign it. The clock runs from the date printed on the form, not the day it arrives.1 If you qualify on the basis of age, disability, long-term services and supports, a Medicare Savings Program, or another non-MAGI pathway, federal rules let Montana follow those same renewal procedures, including the 90-day reconsideration below, but do not require it, so ask DPHHS what applies to you.1

If you declare U.S. citizenship or a satisfactory immigration status and DPHHS cannot promptly verify that status, federal law requires a reasonable opportunity period, which ends at the earlier of verification or 90 days after you receive the notice (deemed five days after its date). During that period the agency may not delay, deny, reduce, or terminate benefits for someone it otherwise finds eligible.7

How to renew Montana Medicaid

A renewal form may be submitted through any of the ways the agency lets you apply, and on the MAGI pathway DPHHS may not require an in-person interview.1 In Montana that means online, by phone, in person, or by mail.

The 90-day reconsideration window

If your coverage closed because you missed the renewal paperwork, you usually do not have to start over with a new application.

Under 42 CFR 435.916, if you lose Medicaid for failure to return the renewal form or requested information (a procedural termination, not an eligibility-based one), DPHHS must reconsider your eligibility and treat the late form as your renewal if you submit it within 90 days of the termination, without requiring a new application. That duty is federal for MAGI-based coverage and a state option for the non-MAGI pathways above, so ask DPHHS.1 Whether a restoration reaches back to the termination date is state-dependent, so ask DPHHS how any gap will be handled.

The distinction that controls your options is procedural versus eligibility-based:

• Procedural termination: you did not respond, did not provide requested documentation, or missed the signature. The 90-day reconsideration applies.
• Eligibility-based termination: DPHHS determined you no longer meet income, residency, citizenship, or a categorical requirement. The 90-day reconsideration does not apply; you must file a new application, and you can also appeal if you disagree with the finding.

The 90-day clock starts on the termination date, not the date of the notice, so read your closure notice carefully. To reopen the case, submit the renewal form through any channel above; if you no longer have it, call the Helpline at 1-888-706-1535 or use apply.mt.gov to request a new one, and note the closure date when you submit so DPHHS routes it as a reconsideration.3

Children, pregnancy, and postpartum coverage

Children have their own protection. Under Section 5112 of the Consolidated Appropriations Act, 2023, every state must give children under age 19 in Medicaid or CHIP 12 months of continuous eligibility from the date of enrollment, effective January 1, 2024.2 In Montana that covers children in Healthy Montana Kids Plus (children's Medicaid) and Healthy Montana Kids (the separate CHIP program, which reaches up to 261% of the federal poverty level).5 If a parent loses Medicaid mid-year because household income climbed, the children stay covered until their next annual renewal.

Limited exceptions still allow a mid-year end: the child turns 19, moves out of Montana, dies, the family voluntarily disenrolls, or there is fraud.

Pregnant women qualify for Montana Medicaid up to 157% of the federal poverty level.5 Federal law also gives states a permanent option to extend postpartum coverage from the old 60-day window to a full 12 months after pregnancy ends, with full benefits throughout.2 Confirm your postpartum end date on your DPHHS notice so you know when the standard annual renewal cycle resumes.

Long-term care and Big Sky Waiver renewals

If you receive Medicaid long-term care, whether in a nursing facility or through the Big Sky Waiver (BSW), the state's main 1915(c) home- and community-based services waiver, renewal has two independent parts, and both must stay current.

Financial redetermination. Conducted by DPHHS at least annually,1 this review runs the asset test through the Asset Verification System6 and reviews:

• Income (Social Security, pensions, annuities) and countable assets against the $2,000 individual limit.3
• The medically needy spend-down, if income is over the $525 monthly medically needy income level, with excess spent down on incurred care costs.3
• The Personal Needs Allowance a nursing-facility resident keeps, which is $50 a month ($30 for an SSI-only resident).3
• Spousal impoverishment protections if you are married: the community spouse may keep half the couple's countable assets up to a maximum Community Spouse Resource Allowance of $162,660 (minimum $32,532) and monthly income up to a maintenance allowance in the federal range of $2,705.00 to $4,066.50.3

Montana applies a 60-month look-back to uncompensated asset transfers.3 After the death of a recipient who was 55 or older when they received Medicaid-paid services, the DPHHS Third Party Liability program pursues estate recovery, and Montana's reachable estate is an expanded one that takes in property passing outside probate. A surviving spouse, or a child under 21, blind, or permanently and totally disabled, bars recovery only while that survivor lives, so the claim is deferred rather than forgiven; heirs may apply for an undue-hardship waiver.8

Level of care reassessment. Separately, the Senior and Long-Term Care Division and its care managers reassess whether you still meet the nursing-facility level of care your benefit requires. The BSW is administered by that division and currently operates a waiting list; referrals are made by contacting Mountain Pacific at (800) 219-7035 or (406) 443-4020.9 A beneficiary can pass the financial redetermination and fail the level-of-care review, or the reverse. If the level-of-care review is not approved, long-term-care Medicaid ends, but you may continue on standard aged, blind, and disabled Medicaid for non-long-term-care coverage if otherwise eligible.

When your mail is returned

The federal rules that once required an agency to search for a new address before acting on mail that comes back as undeliverable were removed from the Code of Federal Regulations effective July 31, 2026. Federal law now says only that an agency may act without advance notice when mail returns with no forwarding address and your whereabouts are unknown, and that coverage must be reinstated if your whereabouts become known while you are still eligible.10 Montana may still have its own returned-mail procedures, so call DPHHS if you think your renewal packet went to an old address.

Montana coordinates care through Passport to Health rather than risk-based health plans, so there is no separate health plan holding a second copy of your address.4 That leaves one place to keep current, and it is worth doing the moment you move:

• Update through apply.mt.gov or call the Helpline at 1-888-706-1535.3
• File a change-of-address form with the post office so mail forwards.

Appealing a termination

If your renewal is denied or your coverage is terminated, you have a federal right to a fair hearing under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220. The agency need not grant one where the sole issue is a change in law that automatically affects a group of beneficiaries.2 Federal law caps the request window at 90 days from the date the notice is mailed, the most a state may allow rather than a floor you are owed: a shorter state deadline binds.4 Montana allows the full 90 days for most decisions, and your request must be received within 90 days of the date the adverse-action notice is mailed. One exception lands on long-term-care families: a hearing request about the Department's determination of your ability to pay for institutional (nursing-home) care must be received within 30 days of mailing.4

Hearing requests must be in writing, though no signature is required; instructions are printed on the back of every adverse-action notice. Contested cases are heard by the DPHHS Office of Administrative Hearings (OAH), reachable at (406) 444-2470. A hearing decision can then be appealed to the Board of Public Assistance (request due within 15 days, extendable to 45 for good cause) and from there to district court (within 30 days of the Board's decision).4 You may also first ask for an Administrative Review, an informal meeting with fair-hearing staff, which does not waive your right to a hearing.

Keeping coverage during the appeal. Federal law continues your Medicaid during an appeal when the agency has sent its advance notice and you request the hearing before the action takes effect. If that date has passed, ask anyway: 42 CFR 431.231 lets the agency reinstate services when you request a hearing no more than 10 days after the date of action.11 Montana implements this by automatically continuing benefits at the same level until the hearing decision when you file between the notice's mailing date and the action's effective date; if timely notice was not sent, benefits continue only if you file within 10 days of receiving the notice (presumed received 5 days after mailing). Continuation is not unconditional: benefits cannot be continued at all where the hearing officer determines the issue is one of state or federal law or policy. If the decision goes to the Department, Montana requires you to repay benefits received during the appeal.4

What is changing after 2026

Section 71107 of the 2025 federal budget-reconciliation law (H.R.1, Public Law 119-21) requires states to redetermine eligibility once every 6 months, rather than every 12 months, for the ACA expansion-adult population, for renewals scheduled on or after January 1, 2027. Its only exemption covers a person the state determines to be an Indian or Urban Indian, a California Indian, or otherwise eligible as an Indian for the Indian Health Service.2 Because Montana adopted ACA Medicaid expansion, a large share of its working-age enrollees will renew twice a year from 2027.

The same 2025 law also shortens retroactive eligibility for applications filed on or after January 1, 2027. The federal window today covers services in or after the third month before the application month; the new rule shortens that to two months for most enrollees and one month for the expansion group. The exact effective date inside the window is a state-plan choice, so confirm what Montana allows with DPHHS rather than assuming the federal maximum.2

Common Montana Medicaid recertification mistakes

1. Treating the renewal notice like junk mail. Open anything from DPHHS, an Office of Public Assistance, or apply.mt.gov the day it arrives.
2. Assuming ex parte will handle everything. If DPHHS cannot renew you from the data it holds, the packet has to come back by the deadline printed on the form.1
3. Not knowing the 90-day reconsideration window exists. A procedural closure can be reconsidered without a new application if you return the form within 90 days.1
4. Missing the asset-verification signature for aged, blind, disabled, or long-term-care renewals. Without your signed authorization DPHHS cannot run the required bank-record check, and federal law lets the state find you ineligible on that basis alone.6
5. Assuming children lose coverage when a parent does. Children under 19 keep 12 months of continuous eligibility regardless of family income changes.2
6. Missing the shorter 30-day appeal window on a nursing-home cost-of-care determination. Most decisions carry a 90-day hearing window, but this one is only 30 days.4
7. Waiting too long to request a hearing. Filing before the action takes effect keeps your coverage running during the appeal; past that date, 42 CFR 431.231 still allows reinstatement if you file within 10 days of it.11

Montana Medicaid renewal contacts

These are the offices that handle renewals, reconsiderations, and appeals.3,4,9

If you are unsure whether your renewal has been processed, log into apply.mt.gov to check your case status or call 1-888-706-1535.3 Brevy's guides to how to apply for Montana Medicaid, Montana Medicaid eligibility and income limits, and the Montana Medicaid hub cover the broader eligibility picture, and you can browse every state's guides on the Medicaid by state directory.

Learn More

Find personalized help renewing your Montana Medicaid coverage 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.