Montana Medicaid Definition
Medicaid in Montana is administered by the Department of Public Health and Human Services (DPHHS) agency.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, health coverage is provided for varying groups of Montana residents, including pregnant women, parents and caretaker relatives, adults without dependent children, disabled individuals, and seniors. While there are differing eligibility groups, this page is focused strictly on Medicaid eligibility for Montana elders, aged 65 and over, and specifically for long term care, whether that be at home, in an adult foster care home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Montana seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Montana offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the eligibility requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, in adult foster care, or in assisted living.
3) Regular Medicaid / Aged, Blind and Disabled – this is an entitlement program, which means as long as eligibility requirements are met, one will receive assistance. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an Montana Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Montana Medicaid. More.
|2019 Montana Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||Income must be equal or less than the cost of nursing home care||$2,000||Nursing Home||Income must be equal or less than the cost of nursing home care||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||Income must be equal or less than the cost of nursing home care||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$771 / month||$2,000||Nursing Home||$1,542 / month (Each spouse is allowed up to $771 / month)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$750 / month||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$771 / month||$2,000||None||$1,157/ month||$3,000||None||$750 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded.
For married couples, with non-applicant spouses’ with insufficient income from which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses do not become impoverished. Basically, if the non-applicant spouse, also called the community spouse, healthy spouse, or well spouse, has income under $2,057.50 / month (this figure changes each year in July), he or she is entitled to a portion of his/her applicant spouse’s income. If the well spouse has income equivalent to $2,057.50 / month or in excess of this amount, the non-applicant spouse may be entitled to a greater portion of his/her applicant spouse’s income if he/she has high shelter and utility costs. As of 2019, the maximum monthly maintenance needs allowance is $3,160.50 / month (this figure changes in January of each year.)
*As mentioned above, for a senior to be eligible for nursing home Medicaid, his/her income must be equal to or less than the cost of care in a nursing home. All of a senior’s income except for a small personal needs allowance must be applied towards his/her cost of nursing home care.
What Defines “Assets”
Countable assets (also called resources) include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are not counted. In other words, they are exempt from the eligibility limit. Exemptions include personal belongings, such as clothing, household furnishings, an automobile, a burial plot, and prepaid funeral agreements. Funeral agreements are limited to $1,500 (in 2019) unless they are irrevocable, and if they are, there is no limit. However, if more than $5,000 was paid into a funeral agreement and all the funds are not used, the remainder must be paid to Montana Medicaid. Combined life insurance policies are limited to a total face value of $5,000 (in 2019), and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the equity value is under $585,000 (in 2019) are also exempt. For married couples, as of 2019, the community spouse can retain half of the couples’ joint assets (up to a maximum of $126,420), as the chart indicates above. However, if a couple’s joint assets are equal or less than $25,824, the non-applicant spouse can keep 100% of it. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished.
It is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Montana has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For Montana elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Montana, the Medically Needy Pathway, also commonly referred to as a Spend-Down Program, allows those who are categorically aged, blind and disabled who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” their excess income (the amount that is over the medically needy income limit) on private health insurance, unpaid medical bills, and medical expenses that Medicaid does not cover. If program participants choose, they can instead make a cash payment to the state to meet their “spend down” rather than meeting it by paying incurred medical bills. (The amount one must “spend down” can be thought of as a deductible.) As of January 2019, the medically needy income limit is $525 / month for a single senior applicant, as well as for a married couple with both spouses applying for Medicaid. Once one has spent their income down to the income limit, Medicaid will kick in for the remainder of the spend down period, which is one month in Montana.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” excess assets to meet the asset limit. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them for less than they are worth. This is because in Montana, Medicaid has a “Look-Back” period of 5 years, and if one is in violation, a period of Medicaid ineligibility will result.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Montana Medicaid Programs
1) HCBS Waiver – this home and community based services Medicaid waiver, also known as the Montana Big Sky Medicaid Waiver, provides benefits to physical disabled adults and seniors who require a nursing home level of care, but choose to live at home or in the community, including assisted living facilities and adult foster care homes. Benefits include private duty nursing, home modifications, specialized medical equipment, and adult day health care. Personal care assistance is also available and program participants are able to select the caregiver of their choosing.
2) Self-Directed Personal Assistance Services (PAS) – also called Montana Community First Choice (CFC), this program provides in-home assistance with activities of daily living and instrumental activities of daily living for elderly and disabled individuals. Available services may include assistance with bathing, toileting, mobility, preparing meals, laundry, and grocery shopping. There is a self-directed option that allows eligible individuals to hire and train their own caregivers.