Montana Medicaid Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Montana Medicaid Long Term Care for seniors. This is different from regular Medicaid, which is for low-income people of all ages. In Montana, Medicaid is administered by the Department of Public Health and Human Services (DPHHS). Montana residents can receive long term care benefits through Montana Medicaid in a nursing home, in their home, the home of a loved one, an adult foster care home, a community adult group home or an assisted living residence through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged, Blind and Disabled (ABD) Medicaid.
Montana Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Montana Medicaid will cover the cost of long term care in a nursing home for eligible Montana residents who require a Nursing Facility Level of Care. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting).
Some of the things Montana Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Nursing Home Medicaid is an entitlement. This means that eligible Montana residents who apply are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved.
Any Montana Medicaid beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $50 / month, as of 2023. This can be spent on personal items such as clothes, snacks, haircuts, etc.
Home and Community Based Service (HCBS) Waivers
Home and Community Based Service (HCBS) Waivers will pay for long term care services and supports that help Montana Medicaid recipients who require a Nursing Facility Level of Care remain, or return to, living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long term care services for Montana residents who live in in their own home, the home of a loved one, an adult foster care home, a community adult group home or an assisted living residence. While Montana’s HCBS Waivers will cover some long term care services and supports in those settings, it will not cover room and board costs.
Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for an HCBS Waiver program in Montana, they are not guaranteed by law to receive the benefits. Instead, there are a limited number of enrollment spots for Montana HCBS Waivers, and once those spots are full additional eligible applicants will be placed on a waiting list.
Montana residents can receive HCBS Waiver long term care benefits through the Montana Big Sky Waiver Program.
Montana Big Sky Waiver Program
The Montana Big Sky Waiver Program provides long term care services and supports to Montana residents who require a Nursing Facility Level of Care but live in their own home, the home of a loved one, an adult foster care home, a community adult group home or an assisted living residence. While the waiver will pay for services in those settings, it will not cover room and board costs. To determine if program applicants require a Nursing Facility Level of Care, a registered nurse employed by Mountain Pacific Quality Health will conduct a Level of Care assessment.
Montana Big Sky Waiver Program benefits include adult day care, chore services, home modifications, housekeeping services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits will be made available depending on the needs and circumstances of each individual.
For Montana Medicaid recipients who reside in a nursing home but wish to return to living in the community, the Big Sky Waiver will pay for a security deposit, utility set-up fees and basic home furnishings to aid in the transition.
The state will provide a licensed caregiver to provide these services and supports, but the Big Sky Waiver program participant also has the option to self-direct some of their benefits. They can hire a caregiver of their choice (including friends, family members and spouses) to provide some of the long term care services like personal care assistance, housekeeping and transportation.
The Montana Big Sky Waiver Program had 2,580 enrollment spots per year as of 2022. Once those spots are full, additional eligible applicants will be placed on a waiting list.
Aged Blind and Disabled Medicaid
Aged, Blind and Disabled (ABD) Medicaid provides healthcare and long term care services and supports to low-income Montana residents who are aged (age 65+), blind or disabled and live in their home, the home of a loved one, an adult foster care home, a community adult group home or an assisted living residence. While ABD Medicaid may cover some services in all of those settings, it will not cover room and board costs. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages.
Montana’s ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.
Montana ABD Medicaid beneficiaries can receive long term care personal service benefits through the Community First Choice/Personal Assistance (CFC/PAS) Programs.
Community First Choice / Personal Assistance Services Programs
Montana seniors who have ABD Medicaid and need help with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) can receive long term care benefits through the Community First Choice/Personal Assistance (CFC/PAS) Programs. The state will screen program applicants to determine if they do need help with their Activities of Daily Living and what types of CFC/PAS services and supports Medicaid will cover.
CFC/PAS Program participants must live in their own home or the home of a loved one. They can not live in adult foster care, assisted living or any other institutional setting.
CFC/PAS Program benefits are centered around personal care assistance with the Activities of Daily Living, but medication management and transportation for medical purposes is also included. The state can provide a licensed caregiver to deliver these benefits, but program participants also have the option to self-direct their CFC/PAS benefits. As long as they are deemed capable of making their own healthcare decisions, they can hire caregivers of their choice, including family members. Spouses, however, can not be hired as caregivers for Montana’s CFC/PAS Program.
Like ABD Medicaid itself, the CFC/PAS Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.
Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and non-medical personal needs into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. Although Montana does not have a PACE program of its own as of 2023, neighboring North Dakota and Wyoming both have programs. While individuals can not transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in their new state as soon as they relocate without any waiting period. More.
Eligibility Criteria For Montana Medicaid’s Long Term Care Programs
To be eligible for Montana Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged, Blind and Disabled (ABD) Medicaid.
Montana Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Montana residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Montana Medicaid. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The income for a single applicant in Montana in 2023 can not exceed the cost of nursing home care. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, stock dividends, alimony, wages, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments. Nursing home care in Montana can range from $6,000-$8,000 / month. However, Montana Nursing Home Medicaid beneficiaries must give the state almost all of their income to help cover the cost of care. They are only allowed to keep $50 / month of their income as a “personal needs allowance.” They may also keep enough income to make any Medicare premium payments they might have.
For married applicants with both spouses applying, the 2023 asset limit for nursing home coverage through Montana Medicaid is $2,000 per spouse, and their combined income can not exceed the cost of nursing home care, but the applicants must give almost all of their income to the state to offset the cost of care (they can keep $50 / month per spouse and enough to make Medicare premium payments). For a married applicant with just one spouse applying, the 2023 asset limit for nursing home coverage through Montana Medicaid is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse. The income of the non-applicant spouse is not counted, and the income of the applicant can not exceed the cost of nursing home care, but they must give most of their income to the state to offset the cost of care. They can keep $50 / month, and enough to make Medicare premium payments. They can also keep enough income to make any allowable spousal income payments to low-income, non-applicant spouses.
Montana Nursing Home Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Montana has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Montana Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry) are taken into consideration when making an assessment on required level of care.
Montana Medicaid Home and Community Based Service (HCBS) Waivers Eligibility Criteria
Financial Requirements
Montana residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2023, the asset limit for HCBS Waivers in Montana is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $914 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2023 asset limit for HCBS Waivers in Montana is $2,000 per spouse, and the income limit is $914 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $914 / month for the applicant. The income of the non-applicant spouse is not counted.
Montana HCBS Waiver applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Montana has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through Montana Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if Montana HCBS Waiver applicants require a Nursing Facility Level of Care, a registered nurse employed by Mountain Pacific Quality Health will conduct a Level of Care assessment. An applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, laundry) are taken into consideration during this assessment.
Montana Aged Blind and Disabled Medicaid Eligibility Criteria
Financial Requirements
Montana residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind and Disabled (ABD) Medicaid. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $914 / month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2023 asset limit for Montana’s ABD Medicaid is $3,000 combined, and the income limit is $1,371 / month combined. This applies to married couples with both spouses applying or with just one spouse applying.
While Montana has a “look-back” period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no “look-back” period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The functional requirement for Aged, Blind and Disabled (ABD) Medicaid in Montana is being age 65 or over, blind or disabled. For ABD Medicaid applicants who require in-home services and supports, Montana Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of services the applicant needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward the asset limit, it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage / debt) is less than $688,000 (as of 2023) then the home is exempt. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $688,000. These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. More on Medicaid & Homeownership.
Applying For Montana Medicaid Long Term Care Programs
The first step in applying for Montana Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged, Blind and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Montana Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Montana Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Montana residents can apply for Medicaid online at the state’s webpage. For assistance with the application process, they can call the Department of Public Health and Human Services Senior and Long Term Care Division at 406-444-4077.
Choosing a Montana Medicaid Nursing Home
After an applicant has been approved for nursing home coverage through Montana Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Montana Medicaid nursing home coverage is an entitlement, it will only cover stays and care in approved nursing homes. Montana residents can use this Montana Department of Public Health and Human Services webpage to search for nursing homes. They can also use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country, to help them find a nursing home. All of the nursing homes on this site are either Medicaid- or Medicare-approved.