Montana Medicaid spousal impoverishment rules protect the at-home spouse's share of assets and monthly income when their partner applies for long-term care coverage. Montana uses a spend-down pathway and does not require a Miller Trust.
How Montana Medicaid Spousal Impoverishment Works
When one spouse needs nursing home care or home- and community-based services through Montana Medicaid, administered by the Montana Department of Public Health and Human Services (DPHHS), the couple's finances are reviewed as part of the eligibility process. Federal spousal impoverishment rules under 42 USC § 1396r-5 require DPHHS to protect a portion of the couple's assets and a monthly income floor for the community spouse, the partner who remains at home.
Montana is a medically needy spend-down state. Applicants with income above the medically needy standard can still qualify by applying excess income toward incurred medical and long-term care costs, without needing to establish a Miller Trust.
The CSRA: How Much Can the Community Spouse Keep?
Calculating the protected share. DPHHS takes a snapshot of the couple's combined countable assets when the Medicaid application is filed. The community spouse keeps half of that total, within the federal minimum and maximum.
- Minimum: $32,532. Even if half the couple's assets is below this floor, the community spouse keeps $32,532.
- Maximum: $162,660. Even if half exceeds this figure, the protected share is capped here.
For a couple with $60,000 in countable assets, the community spouse keeps $30,000. For a couple with $22,000, the community spouse keeps the full $22,000 under the minimum. For a couple with $380,000, the community spouse keeps $162,660.
After the community spouse's share is reserved, the applicant's remaining countable assets must be spent down to $2,000 before Montana Medicaid covers care.
Exempt assets. Certain assets are not counted toward the CSRA snapshot or the Medicaid asset limit:
- The primary home (community spouse residing there), up to $752,000 in equity
- One vehicle used for household transportation
- Household furnishings and personal belongings
- Prepaid irrevocable funeral and burial contracts
Income Protection: The MMMNA in Montana
The MMMNA sets the minimum monthly income the community spouse must be left with after the institutionalized spouse's income is accounted for.
2026 MMMNA range. The federal floor is $2,643.75 per month (effective July 1, 2025) and the ceiling is $4,066.50 per month (effective January 1, 2026). Montana follows these federal figures.
If the community spouse's own income from Social Security, a pension, or other sources already reaches or exceeds $2,643.75 per month, no income is redirected from the Medicaid applicant. If the community spouse falls below that floor, DPHHS will allow a portion of the applicant's income to be diverted to close the gap.
The shelter standard. The MMMNA can be raised above the floor if the community spouse's housing costs exceed the federal shelter standard of $793.13 per month. The allowed increase brings the MMMNA up to the $4,066.50 ceiling. DPHHS uses actual documented housing costs, including rent or mortgage payment, property taxes, homeowners insurance, and utilities, to make this determination.
Requesting an adjustment. If the standard calculation does not adequately cover the community spouse's living expenses, Montana provides a fair hearing process. Presenting itemized monthly expenses is the most effective way to support a higher MMMNA.
Montana's Medically Needy Spend-Down
Montana operates a medically needy program for long-term care, meaning applicants who exceed the medically needy income standard can still qualify by incurring and applying medical expenses at least equal to the excess. No Qualified Income Trust or Miller Trust is required.
In a nursing facility, the resident's income above allowances is applied toward the monthly care bill. DPHHS pays the remainder. The Montana nursing facility Personal Needs Allowance is $50 per month.
Home Equity and Estate Recovery
The primary home is exempt while the community spouse lives in it and equity is below $752,000. Montana's estate recovery program may seek reimbursement from the Medicaid recipient's estate after death, but federal law prevents any estate recovery action while the community spouse remains alive.
How to Apply for Montana Long-Term Care Medicaid
Families can apply through:
- Online: apply.mt.gov
- Phone: Montana Public Assistance Helpline at 1-888-706-1535
- In person: A local Office of Public Assistance
Montana applies a 60-month look-back to uncompensated transfers. Gifts or below-market-value transfers made within five years of the application date can result in a penalty period during which Medicaid will not pay for care.
Frequently Asked Questions
No. Montana is a medically needy spend-down state and does not require a Qualified Income Trust (Miller Trust). Over-income applicants qualify through the spend-down process instead.
If the community spouse's monthly income falls below the MMMNA floor of $2,643.75, DPHHS can redirect up to that amount from the institutionalized spouse's income to the at-home spouse. If housing costs are high enough, the MMMNA can be increased to the $4,066.50 ceiling.
A nursing facility resident contributes all income above protected amounts, primarily the $50 Personal Needs Allowance and any MMMNA diversion to the community spouse, toward the facility's monthly bill. Montana Medicaid pays the difference between the resident's contribution and the facility's Medicaid rate.
Montana's 60-month look-back makes uncompensated transfers within five years of the application date subject to penalty. The penalty period is calculated by dividing the transferred amount by the average monthly nursing home cost in Montana, resulting in a period during which Medicaid will not cover care.
No. The community spouse keeps their protected CSRA share. Only the applicant's share of countable assets, after the CSRA is set aside, must be spent down to $2,000.
Find personalized help understanding Montana Medicaid spousal impoverishment rules at brevy.com.
Learn More
- Montana Medicaid Eligibility and Income Limits
- How to Apply for Montana Medicaid Long-Term Care
- Medicaid Planning Strategies for Seniors
Find personalized help navigating Montana Medicaid spousal impoverishment rules 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.