Medicaid Long-Term Care Guide in Montana
Long-term care eligibility, benefits, and how to apply through the Montana Department of Public Health and Human Services (DPHHS).
What makes Montana Medicaid different
Medicaid in Montana is jointly funded by the state and federal government but administered by the state under federally set parameters. The Montana DPHHS is the administering agency. In addition to nursing home care, MT Medicaid pays for care services and supports to assist frail seniors in continuing to live at home, adult foster care, or assisted living.
Administered by the Montana Department of Public Health and Human Services (DPHHS).
Program Types
Institutional / Nursing Home Medicaid
An entitlement; anyone who meets the eligibility requirements will receive assistance. Benefits are provided in Medicaid-certified nursing home facilities.
Level of care: Nursing Home
Medicaid Waivers / Home and Community Based Services (HCBS)
Not an entitlement; 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, adult foster care, or assisted living.
Level of care: Nursing Home
Regular Medicaid / Aged, Blind and Disabled
An entitlement; if eligibility requirements are met, assistance will be received. While Regular Medicaid is not Long-Term Care Medicaid, some long-term care benefits, such as personal care assistance or adult day care, may be available.
Level of care: Help with ADLs
2026 Montana Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid*
Medicaid Waivers / Home and Community Based Services†
Regular Medicaid / Aged Blind and Disabled
*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $50 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
Explore Montana Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Montana.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — Montana
How the main LTC programs available in Montana compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $14–17/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in Montana | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Montana Medicaid programs
HCBS Waiver
Older Montanans
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Montana
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in MontanaHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: DPHHS · dphhs.mt.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Montana
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Montana. The process typically takes 45–90 days from application to first paycheck.
Apply in Montana: DPHHS · dphhs.mt.gov
Medicaid Eligibility Screener — Montana
Answer 7 quick questions — we'll check the financial and care requirements for Montana and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly all income is counted, including employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends.
- Nationally, Holocaust restitution payments are not counted as income.
- In MT, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count.
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,644 (eff. 7/1/25 – 6/30/26). If a non-applicant's income falls under this amount, income can be transferred from the applicant spouse.
- A non-applicant spouse can increase their Spousal Income Allowance if housing/utility costs exceed a shelter standard of $794 / month (eff. 7/1/25 – 6/30/26), up to a Maximum MMMNA of $4,067 / month.
- For Regular Medicaid, both spouses' income is counted. There is no MMMNA for a non-applicant spouse.
- In Montana, persons eligible for SSI are automatically approved for Medicaid, including long-term care via Regular Medicaid given functional need requirements are met.
- Countable assets include cash, stocks, bonds, investments, cryptocurrency, promissory notes, bank accounts (money market, savings, checking), and real estate in which one does not reside.
- In Montana, IRAs and 401Ks are counted as assets.
- Non-countable (exempt) assets include personal belongings, household furnishings, an automobile, burial spaces for the applicant and immediate family, prepaid irrevocable funeral agreements (no limit, but if balance was originally over $5,000, remaining funds go to Montana Medicaid), combined life insurance policies up to $5,000 face value, and generally one's primary home.
- All assets of a married couple are considered jointly owned regardless of the Medicaid program.
- The CSRA allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If the non-applicant's share is under $32,532, up to $32,532 can be retained.
- There is no CSRA for Regular Medicaid.
- The home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.
- If this is not the case, there is a home equity interest limit of $730,000 (in 2026).
- Home equity is the value of the home minus any outstanding debt. Equity interest is the amount of equity owned by the applicant.
- If neither the applicant nor qualifying family live in the home, the applicant must have Intent to Return.
- There is no home equity interest limit for Regular Medicaid.
- The home is NOT exempt from Medicaid's Estate Recovery Program (MERP). After a beneficiary's death, the Montana Medicaid agency attempts reimbursement of care costs through the deceased's estate.
- Montana has a 60-month (5-year) Look-Back Period for Nursing Home Medicaid and Medicaid Waiver applications.
- Medicaid checks all asset transfers, including those by a spouse, to ensure none were gifted or sold for less than fair market value.
- Violations result in a Penalty Period of Medicaid ineligibility.
- The Look-Back Period does not apply to Regular Medicaid.
- The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule still violates the Look-Back Period.
- MMMNA: $2,644 · CSRA: $162,660 · CSRA Min: $32,532
- When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
- The MMMNA is $2,644 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
- A non-applicant can increase their Spousal Income Allowance if housing/utility costs exceed the shelter standard of $794 / month, up to a maximum of $4,067 / month.
- The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
- For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.
- Medically Needy Pathway — Montana has a Spend-Down Program. The MNIL is $525 / month for both single applicants and married couples. The spend-down is calculated monthly. Participants can make a cash payment to the state to meet their spend-down rather than paying medical expenses. The medically needy asset limit is $2,000 (individual) and $3,000 (couple).
- Asset Spend-Down — Spend excess assets on non-countable items such as home modifications (wheelchair ramps, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof the Look-Back Rule was not violated.
- Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.
Montana does not use Qualified Income Trusts (Miller Trusts). The Medically Needy / Spend-Down program is available for persons over the income limit. Uniquely, Montana allows a cash payment to the state to meet the spend-down obligation.
Montana Medicaid Programs
Big Sky Waiver (BSW) / HCBS Waiver
Benefits for seniors and persons with physical disabilities who require a Nursing Home Level of Care but choose to live at home or in the community, including assisted living and adult foster care. Services include private duty nursing, home modifications, specialized medical equipment, adult day health care, and personal care assistance. Participants can select their own caregiver, including adult children or spouses.
Community First Choice Services (CFCS) & Personal Care Services (PCS)
In-home assistance with daily living activities (bathing, toileting, mobility, meal preparation, laundry, grocery shopping) for elderly or disabled persons. A self-directed option allows hiring and training one's own caregivers, including adult children (but not spouses).
Money Follows the Person (MFP)
A federal program that helps institutionalized Medicaid-eligible persons transition back home or into the community.
How to Apply
- Apply online at apply.mt.gov
- Apply via a local Field Office of Public Assistance
- Call the DPHHS Senior and Long Term Care Division at 406-444-4077
- Call the Montana Public Assistance Helpline at 888-706-1535
Prior to applying, it is extremely important that applicants are certain they meet all eligibility requirements. Medicaid Planning may mean the difference between approval and denial of benefits.
More Montana Long-Term Care Resources
Take the Next Step for Montana Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- Montana Department of Public Health and Human Services (DPHHS) — Montana Medicaid — Official site