Long-Term Care Medicaid in Montana: 2026 Guide

In Montana, Medicaid is run by the Montana Department of Public Health and Human Services (DPHHS). Eligibility is decided through county Offices of Public Assistance, and home care is run by the Senior and Long-Term Care Division. Long-Term Care Medicaid can pay for nursing facility care and for care at home through the Big Sky Waiver. This guide explains the 2026 rules in plain language.

At a glance: Montana 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with Montana DPHHS before relying on them.

What Long-Term Care Medicaid covers in Montana

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

Big Sky Waiver (BSW). For people 65 and older and people with physical disabilities who are financially eligible for Medicaid, meet nursing facility level of care and have a need only BSW services can meet. A case management team (a nurse and a social worker) builds your plan of care. Services can include personal assistance, homemaker and chore help, adult day health, adult foster care, assisted living, nursing and therapies, emergency response systems, home and vehicle changes, respite and self-direction. BSW is not an entitlement and has a waiting list. Openings go to the people most in need, scored with a statewide tool.

Other programs. Montana has other waivers and Community First Choice services.

How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in Montana and be a U.S. citizen or qualified non-citizen;
• meet a nursing facility level of care, based on a level of care determination by the state’s contractor;
• meet the income and asset rules below, as decided by DPHHS.

Income rules

Montana does not use a fixed income cap for nursing home Medicaid. You can be income-eligible if the monthly cost of your nursing home care equals or is more than your monthly income.

Once you are on Medicaid in a nursing facility, most of your income goes to the facility. You keep a personal needs allowance of $50 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

An unmarried person in long-term care, or the spouse in care, can have up to $2,000 in countable resources. For a couple who both need care, the limit is $3,000.

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within Montana DPHHS rules

Spousal protections

• Assets: The spouse at home can keep the greater of half the couple’s countable resources (up to $162,660) or $32,532 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income. If it is below the $2,705 a month basic needs standard (from July 1, 2026), part of the applicant’s income can go to them, up to $4,067 a month.

Look-back and penalties

When you apply, Montana looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($343.30 a day ($10,299 a month), from July 1, 2026; Montana counts the penalty in days).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $343.30 is about 146 days (about 4.9 months) without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Montana

Montana’s estate recovery program is run by DPHHS.

• What is recovered: Medicaid paid for long-term care and related services received at age 55 or older, and for some people of any age in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: the state must have a way to waive recovery when it would cause undue hardship. Ask Montana DPHHS for the current rules.
• Family members and personal representatives can contact Montana DPHHS with questions.

How to apply

• For Medicaid: apply online at apply.mt.gov, or get help from your county Office of Public Assistance.
• For the Big Sky Waiver: ask for a level of care referral from the state’s contractor, Mountain Pacific Quality Health. See the BSW page.

Applying for a spouse or parent. If you are applying for someone else, you may need legal authority to act for them, or you can be named as an authorized representative on the application. Gather statements for every account, not just the main one, and write down when the person’s care needs began. If the person is already in a nursing home, ask the facility’s business office or social worker which Medicaid forms they need from you and when, and tell the agency if any requested document is hard to get, since agencies can often give extra time when you ask before the deadline.

After you apply. Montana DPHHS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Montana

• DPHHS and county Offices of Public Assistance: applications and eligibility.
• Senior and Long-Term Care Division: Big Sky Waiver and home care questions.
• SHIP (State Health Insurance Assistance Program): free Medicare counseling.
• Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and other long-term care settings.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Montana:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Montana’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Montana’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Montana Big Sky Waiver
• Montana Community First Choice Services and Personal Care Services

Frequently asked questions

Does Montana have an income limit for nursing home Medicaid? Not a fixed one. You can qualify on income if your monthly nursing home cost is at least as much as your monthly income.

Is there a wait for the Big Sky Waiver? Yes. BSW has a waiting list, and openings go to the people most in need.

How much can my spouse keep? In 2026, the greater of half the couple’s assets (up to $162,660) or $32,532, plus the home, a car and belongings.

How long is the penalty for a gift? Montana counts the penalty in days: divide the gift by $343.30. A $20,000 gift would mean about 58 days without Medicaid payment for long-term care.

Will the state take my home after I die? Montana DPHHS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with Montana DPHHS before relying on them.

Sources

• DPHHS, ABD 013
• DPHHS, CMA 001
• DPHHS, ABD 805-2 (PNA)
• DPHHS, CMA 404-2 (penalty divisor)
• DPHHS, Big Sky Waiver Program
• DPHHS, BSW one-sheet
• DPHHS, BSW 406 wait list criteria
• Medicare.gov, Skilled nursing facility care
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.