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.
This page covers Medicaid eligibility for Montana elders, aged 65 and over. Specifically, the focus is on long term care, whether that be at home, an adult foster care home, a nursing home, or 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 varying financial and medical (functional) eligibility requirements, as well as benefits. Further complicating Medicaid eligibility are the facts that the requirements vary with marital status and that Montana offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who meets the eligibility requirements will receive assistance. Benefits are only provided in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; There are a limited number of participant enrollment slots and wait lists may exist. Services are intended to delay and prevent nursing home admissions and can be provided at home, adult day care, in adult foster care, or in assisted living. Learn more about Waivers.
3) Regular Medicaid / Aged, Blind and Disabled – This is an entitlement program; If eligibility requirements are met, assistance will be received. Long-term care benefits, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Montana Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria below does not mean one is ineligible or cannot become eligible for Montana Medicaid. More.
|2022 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 less than nursing home costs*||$2,000||Nursing Home||Income must be less than nursing home costs*||$4,000 ($2,000 per spouse)||Nursing Home||Applicant’s income must be less than nursing home costs*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$841 / month||$2,000||Nursing Home||$1,682 / month ($841 / month per spouse)||$4,000 ($2,000 per spouse)||Nursing Home||$841 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. Income can come from any source and includes employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Holocaust restitution payments and Covid-19 stimulus checks are not considered income and do not impact Medicaid eligibility.
For nursing home Medicaid or a HCBS Medicaid Waiver, the income of a non-applicant spouse is not counted towards the applicant spouse’s income eligibility. Only the income of the applicant spouse is counted. However, the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse to prevent spousal impoverishment. The MMMNA is said to be the minimum amount of monthly income a non-applicant requires to avoid living in poverty. The MMMNA is $2,177.50 (effective 7/1/21 – 6/30/22). If a non-applicant’s monthly income is under $2,177.50, income can be transferred from their applicant spouse to bring their income up to this amount.
In Montana, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $653.25 / month (effective 7/1/21 – 6/30/22). However, in no case can a spousal income allowance put a non-applicant’s income over $3,435 / month (in 2022).This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal allowance is calculated.
In addition to providing spousal support, the monthly maintenance needs allowance is effective in lowering the applicant’s countable income for eligibility purposes.
For Regular Medicaid / Aged, Blind and Disabled Medicaid, income is counted differently when only one spouse applies; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. More about how Medicaid counts income.
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. For Medicaid eligibility purposes, there are also 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 irrevocable funeral agreements. Irrevocable means the terms of the agreement cannot be changed or cancelled. Funeral agreements that are not irrevocable are limited to $1,500 for exemption. While there is no limit for irrevocable funeral agreements, if the balance was more than $5,000, any remaining funds must be paid to Montana Medicaid. Combined life insurance policies are also exempt up to a total face value of $5,000. Finally, one’s primary home is exempt, given the Medicaid applicant lives in it or has intent to return and their home equity is not greater than $636,000 (in 2022). Home equity interest is the amount of the home’s value owned by the applicant. If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant spouse lives and their equity interest in the home. For seniors applying for Regular Medicaid, there is no home equity limit.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which a senior is applying. However, the non-applicant spouse of a nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ joint assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the non-applicant.
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 60-month (5 year) Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During the “look back”, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. If one violated the look-back period, they 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 – Montana has a Spend-Down Program that allows seniors who have income over Medicaid’s limit to qualify for Medicaid if they have high medical expenses. Via this pathway, seniors “spend down” their income on private health insurance, unpaid medical bills, and medical expenses that Medicaid does not cover. The amount one must “spend down” is the difference between one’s monthly income and the medically needy income limit. This can be thought of as a deductible. In 2022, 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. Program participants have the option of making a cash payment to the state to meet their “spend down” rather than meeting it by paying medical bills. Once one’s spend down has been met, they will be income eligible for Medicaid services for the remainder of the month. The asset limit for this program is $2,000 for an individual and $3,000 for a couple. Learn more about the medically needy pathway.
2) Asset Spend Down – Seniors who have assets over MT Medicaid’s limit can “spend down” assets and become asset eligible. This can be done by spending excess assets on non-countable ones, such as home modifications (i.e., wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, when spending down assets, it’s important that one does not give away assets or sell them for less than they are worth. Doing so violates MT Medicaid’s “Look-Back” period of 5 years. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.
3) 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 these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them not only become Medicaid eligible but also to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Montana Medicaid Programs
1) HCBS Waiver – Also called the Montana Big Sky Medicaid Waiver, this program provides benefits to physically 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.
How to Apply for Montana Medicaid
In Montana, seniors can fill out an application for Medicaid benefits at apply.mt.gov. To learn more about Montana’s Medicaid programs or for assistance with the application process, call 406-444-4077 to reach the Department of Public Health and Human Services (DPHHS) Senior and Long Term Care Division. Persons can also contact their local Field Office of Public Assistance for assistance. To find your local office, click here. Alternatively, persons can call the Montana Public Assistance Helpline at 888-706-1535.
Prior to applying for Montana Medicaid, it is extremely important that applicants are certain that they meet all of the eligibility requirements that are covered on this page. If the criteria is not met, or if one is unsure, Medicaid planning may mean the difference between approval and denial of benefits. Furthermore, the Medicaid application process can be complicated, confusing, and time consuming. Learn more about Medicaid’s long-term care application process.