Montana Medicaid Spousal Impoverishment 2026: CSRA Guide

When a husband or wife moves into a nursing home, the financial ground shifts fast for the spouse who stays home. Montana Medicaid spousal impoverishment rules protect that at-home spouse. In 2026 they can keep the greater of $32,532 or half the couple's countable assets (the half is capped at $162,660), and a hearing or court order can set a higher amount.1 If their own income is low, part of the nursing-home spouse's income can be shifted to them, measured against a $2,705 monthly standard. This guide explains how those protections work through Montana Medicaid.2

How Montana Medicaid Spousal Impoverishment Works

When one spouse needs nursing-facility care or a home- and community-based services waiver, the couple must meet strict asset and income limits to qualify. Without protections, the healthy spouse at home could be left nearly penniless while paying for a partner's care. Federal spousal impoverishment law, codified at 42 U.S.C. 1396r-5, prevents that by reserving a portion of the couple's resources and income for the community spouse, the partner who remains at home.2

Montana applies these federal rules through the Montana Department of Public Health and Human Services (DPHHS), which sets Medicaid policy and determines eligibility. The two protections are the Community Spouse Resource Allowance (CSRA) on assets and the Minimum Monthly Maintenance Needs Allowance (MMMNA) on income.

Montana runs a medically needy program for aged, blind and disabled residents. An applicant whose income is above the medically needy income level can still qualify by meeting a spend-down, using incurred medical bills, a cash payment to the department, or both.1

The Montana CSRA: How Much Can the Community Spouse Keep?

The Community Spouse Resource Allowance determines how much of the couple's combined countable assets the at-home spouse may keep.

Calculating the CSRA. DPHHS adds up the couple's combined countable resources. Montana's allowance (its manual calls it the community spouse resource maintenance allowance) is not a flat half. It is the greatest of four amounts: half the couple's combined countable resources, capped at $162,660; the $32,532 minimum; an amount a hearings officer sets; or an amount a court orders.1

• The $32,532 minimum. If half the couple's assets comes to less than $32,532, the at-home spouse keeps up to $32,532.1
• The $162,660 cap on the half. Only the one-half route stops at $162,660. A hearing or a court order can leave the at-home spouse more than that.1,2

In practice, before any hearing or court order: a couple with $60,000 in countable assets leaves the community spouse $32,532, because half ($30,000) is below the minimum. A couple with $22,000 leaves the community spouse the full $22,000, because the whole amount is under the minimum. A couple with $380,000 leaves the community spouse $162,660, because the half ($190,000) is over the cap.1

Countable vs. exempt assets. Not everything the couple owns counts. No current Montana manual we rely on lists the exempt resources. DPHHS's consumer brochure, which says it is current only as of January 2017, lists these as exempt, each under conditions it doesn't spell out:

• A house (under certain circumstances; see the home-equity section below)
• Most personal effects and ordinary household goods
• One car (under certain circumstances)
• Life insurance with a low face value
• Burial plots, and a limited burial fund or an irrevocable burial contract

Confirm the current exempt list with your local Office of Public Assistance before you rely on it.1

The institutionalized spouse's share. After the community spouse's CSRA is set aside, the applicant must spend their remaining countable assets down to Montana's $2,000 individual resource limit before Medicaid will pay for care.1

Income Protection: The MMMNA in Montana

The MMMNA is the income counterpart to the CSRA. It doesn't limit the at-home spouse's own income. Instead, it sizes an allowance that can be paid to them out of the nursing-home spouse's income, so the cost of care doesn't leave the at-home spouse short.1

The figures for 2026. The federal minimum monthly maintenance needs allowance is $2,705.00 (effective July 1, 2026 through June 30, 2027), and the federal maximum is $4,066.50 (effective January 1, 2026).2 Montana's manual uses the same $2,705 basic needs standard and prints the maximum as $4,067.1

How Montana figures the allowance. The community spouse income allowance is the lesser of two amounts: $4,067 minus the at-home spouse's own gross monthly income, or $2,705 plus any shelter costs above the $811.50 basic shelter allowance, minus that same gross income. So an at-home spouse with little income of their own, or high housing costs, gets a larger allowance, and one whose own income already covers the standard may get none. Two conditions apply: the nursing-home spouse can refuse the allowance, and it counts only if the money is actually transferred to the at-home spouse.1

The excess-shelter adjustment. Shelter costs for the at-home spouse's principal residence that exceed $811.50 a month (the federal figure effective July 1, 2026) are added to the $2,705 standard, which is how an allowance can climb toward the $4,067 cap.2,1

Requesting a higher allowance. If either spouse is unhappy with the income allowance, they're entitled to a fair hearing. If they show the at-home spouse needs more income because of exceptional circumstances resulting in significant financial duress, a higher amount can be substituted. A court order requiring the nursing-home spouse to pay support also sets a floor for the allowance. Itemized monthly expenses (mortgage or rent statements, utility bills, property-tax records) help document the need, and an elder-law attorney can help build the case.1

Montana's Medically Needy Spend-Down

Montana's aged, blind and disabled medically needy income level is $525 a month. An applicant above it can establish coverage by meeting a spend-down obligation with incurred medical expenses, by paying the spend-down amount to the department in cash, or by combining the two.1

One question the sources we rely on don't settle: whether Montana sets a separate income cap for nursing-home eligibility, and whether an applicant over such a cap would need a Qualified Income Trust (Miller trust). Ask your local Office of Public Assistance before you rely on either answer.1

In a nursing facility, the resident's gross monthly income, less allowable deductions, is applied to the cost of care, and Medicaid pays the rest. The Montana nursing-facility Personal Needs Allowance is $50 per month (a resident who receives only SSI keeps $30).1

The Home Exemption and Equity Limit

DPHHS's brochure lists a house as exempt under certain circumstances, and federal law adds a home-equity limit for long-term care.1 For 2026 that limit is $752,000 unless the state elects a higher amount, up to $1,130,000. That limit does not apply at all while the applicant's spouse, a child under 21, or a blind or permanently and totally disabled child lawfully lives in the home, so home equity of any amount can't by itself block eligibility while the community spouse lives there. An applicant whose equity is over the limit can also use a reverse mortgage or home equity loan to bring it down.3

Montana Estate Recovery After Death

After the institutionalized spouse passes away, Montana law generally requires DPHHS to present a claim against the recipient's estate for the recoverable Medicaid it paid. Montana law bars that recovery while there is a surviving spouse, so nothing is collected from the recipient's estate during the community spouse's lifetime. That bar is a deferral, not forgiveness: the statute says it does not stop the department from recovering from the recipient's estate after the surviving spouse dies. DPHHS's pamphlet also says the state can recover from the estate of a surviving spouse who dies within three years of the recipient, limited to the value of property that spouse received from the recipient and never more than what Medicaid paid. Montana uses an expanded estate definition that reaches property outside probate, including property passing through joint tenancy or tenancy in common, and property transferred by beneficiary (transfer-on-death) deed or quitclaim deed. Every estate claim must include notice of the right to seek an undue-hardship exception. For how Montana defines the recoverable estate and its exceptions, see our Montana Medicaid estate recovery guide.4

The Look-Back Period

Montana applies a 60-month (five-year) look-back to uncompensated asset transfers when determining long-term-care eligibility.1 Under federal law, transfers for less than fair market value in that window can trigger a penalty period during which Medicaid will not pay for nursing-facility or waiver care. Transfers to your spouse, or to another person for your spouse's sole benefit, are exempt, so assets can be retitled into the community spouse's name without penalty. Retitling doesn't shrink the count, though: the CSRA still starts from the couple's combined countable resources.3,1

How to Apply for Montana Long-Term Care Medicaid

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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.