Montana
What Is Montana Medicaid Long-Term Care?
Montana Medicaid is a joint state and federal health coverage program designed for individuals with low income. For those aged 65 and older, it offers long-term care services not only in nursing homes but also in assisted living, adult foster care, and home settings. The program includes three types of long-term care assistance for seniors in Montana.
What Are the Three Types of Medicaid Long-Term Care Programs in Montana?
- Institutional/Nursing Home Medicaid: This entitlement program guarantees benefits for all who qualify, but services are restricted to licensed nursing facilities.
- Home and Community Based Services (HCBS) Waivers: These are limited-enrollment programs that help delay nursing home admission by offering services at home or in community settings such as adult day care or assisted living. Waitlists may apply.
- Regular Medicaid for the Aged, Blind, and Disabled (ABD): This entitlement provides long-term services like help with daily tasks to those who qualify medically and financially.
What Are the 2025 Income and Asset Limits for Montana Medicaid Long-Term Care?
Financial and medical eligibility criteria vary across the three Medicaid long-term care programs. The chart below gives a quick look at income and asset limits for single and married applicants in 2025.
| Type of Medicaid | Single Applicant | Married (Both Applying) | Married (One Applying) |
|---|---|---|---|
| Institutional / Nursing Home Medicaid | Income must be less than nursing home costs Asset limit: $2,000 Level of Care: Nursing Home | Income must be less than nursing home costs Asset limit: $4,000 ($2,000 each) Level of Care: Nursing Home | Applicant income must be less than nursing home costs Asset limit: $2,000 (applicant) + $157,920 (non-applicant) Level of Care: Nursing Home |
| HCBS / Home and Community Based Services Waivers | Income limit: $967/month† Asset limit: $2,000 Level of Care: Nursing Home | Income limit: $1,934/month ($967 each)† Asset limit: $4,000 ($2,000 each) Level of Care: Nursing Home | Income limit: $967/month (applicant)† Asset limit: $2,000 (applicant) + $157,920 (non-applicant) Level of Care: Nursing Home |
| Regular Medicaid / Aged, Blind & Disabled (ABD) | Income limit: $967/month Asset limit: $2,000 Level of Care: Assistance with ADLs | Income limit: $1,450/month Asset limit: $3,000 Level of Care: Assistance with ADLs | Income limit: $1,450/month Asset limit: $3,000 Level of Care: Assistance with ADLs |
Note: For nursing home Medicaid, almost all income (excluding a $50 personal needs allowance, Medicare premiums, and possibly a spousal allowance) must be paid toward the cost of care. This is referred to as “patient liability.”
† Based on care setting, an applicant may not retain income up to the full limit listed.
Important: Not meeting all of the criteria listed does not automatically mean someone is ineligible for Montana Medicaid. Eligibility pathways and planning strategies may still apply.
Note: Exceeding the limits doesn’t necessarily mean ineligibility. Medicaid planning and spend-down options may help applicants qualify.
What Are the General Financial Limits for a Single Applicant in 2025?
- Income: Must be less than the cost of nursing home care
- Assets: Limited to $2,000
- Medical Need: Must require a nursing home level of care
What Counts as Income for Montana Medicaid?
Most types of income are counted, including wages, Social Security, pensions, alimony, and dividends. Exceptions include Holocaust restitution and VA Aid & Attendance payments. For nursing home applicants, nearly all income must be paid to the facility, minus a small personal allowance and certain deductions.
How Is Income Treated for Married Couples?
If only one spouse is applying, only the applicant’s income is considered. The non-applicant spouse may receive a Monthly Maintenance Needs Allowance to ensure they are not left in financial hardship.
As of July 2025, the minimum allowance is $2,644/month, and can be increased if housing expenses are high, up to a maximum of $3,948/month.
What Assets Count Toward Montana Medicaid Limits?
Countable assets include cash, bank accounts, investments, and real estate not occupied by the applicant. Montana also considers IRAs and 401(k)s as countable. However, several assets are exempt, such as personal items, one vehicle, a primary home (with limits), and irrevocable burial plans.
How Are Assets Evaluated for Married Couples?
All assets are considered jointly owned. However, the non-applicant spouse can retain a portion of the couple’s assets, known as the Community Spouse Resource Allowance (CSRA). In 2025, the maximum is $157,920, and the minimum is $31,584.
What Is Montana’s Medicaid Look-Back Period?
Montana enforces a 5-year look-back for Nursing Home Medicaid and Waiver applicants. During this time, asset transfers are reviewed for below-market sales or gifts. Violations can result in a period of Medicaid ineligibility.
Does the Federal Gift Tax Limit Affect Medicaid?
No. Even if gifting falls under the federal exemption (e.g., $19,000 in 2025), it still violates Medicaid’s look-back rules.
Is My Home Protected from Medicaid?
The primary home is usually exempt if the applicant or spouse resides in it. If not, the applicant must show intent to return, and the home equity must be below $730,000 (in 2025). Note that the home may still be subject to estate recovery after death unless proper planning is in place.
What Medical Criteria Must Be Met?
Applicants must demonstrate a medical need. For Nursing Home Medicaid and Waivers, this means requiring a Nursing Facility Level of Care (NFLOC). For Regular Medicaid, a need for help with activities of daily living may be sufficient.
Can I Still Qualify If I’m Over the Limits?
What Is the Medically Needy Pathway?
Montana offers a spend-down option for those with high medical expenses and income above Medicaid limits. Once the difference is paid down (like a deductible), the applicant becomes eligible for Medicaid for the rest of the month. In 2025, the income limit is $525/month and the asset limits are $2,000 (individual) or $3,000 (couple).
How Can Excess Assets Be Spent Down?
Applicants can spend excess assets on exempt resources like home modifications, burial plans, or debt repayment. These expenditures must not violate the look-back rule. Documentation is essential.
What Is Medicaid Planning?
For those over income or asset limits but unable to afford care, professional Medicaid planning can help. Strategies may involve trusts, annuities, or restructuring assets to both qualify for Medicaid and preserve family inheritance.
What Long-Term Care Programs Does Montana Medicaid Offer?
HCBS / Big Sky Waiver
This program provides nursing home-level care in home or community settings. Services may include personal care, medical equipment, adult day care, and even hiring a family member as caregiver, including spouses.
Self-Directed PAS / Community First Choice Services
This option offers help with daily living (e.g., bathing, shopping) in one’s own home. Beneficiaries can choose and manage their own caregivers, except for spouses.
Money Follows the Person (MFP)
This federal program helps individuals transition from institutions back to home or community settings while maintaining Medicaid eligibility.
How Can I Apply for Montana Medicaid?
Montana residents can apply online at apply.mt.gov or by visiting a local Field Office of Public Assistance. Assistance is also available by calling the DPHHS Long Term Care Division at 406-444-4077 or the Public Assistance Helpline at 888-706-1535.
Should I Apply on My Own?
If you’re unsure whether you qualify, or your financial situation is complex, working with a Medicaid planner could be the key to getting approved and protecting your assets.
