Montana Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Montana Medicaid Long Term Care for seniors, which is run by the Department of Public Health and Human Services (DPHHS) and will pay for care for Montana residents in a nursing home, in their home and in other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different from regular Medicaid, which is for financially limited people of all ages.

 

Montana Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Montana Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Montana seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Montana Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover their nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Montana Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Montana Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Montana’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.

 

Home and Community Based Services (HCBS) Waivers

Montana Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Montana seniors 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.

Montana seniors 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 cover expenses like security deposits, utility set-up fees and basic home furnishings to aid in the transition.

The state can assign 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.

Unlike Nursing Home Medicaid, HCBS Waivers are not an entitlement. Remember, entitlement means guaranteed by law. Instead, there are a limited number of enrollment spots for each waiver program, and once those spots are full, additional eligible applicants are placed on a waitlist. The Montana Big Sky Waiver Program had roughly 2,600 enrollment spots per year as of 2022.

 

Aged, Blind, and Disabled Medicaid

Montana’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to Montana seniors with limited financial means who are aged (65 and over), blind or disabled and live in the community. 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. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

Montana ABD Medicaid beneficiaries who show a need for long-term care benefits can receive some of them 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 long-term care coverages into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare coverage 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. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Montana does not have a PACE program of its own as of 2024, neighboring North Dakota does have a program. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

 

Eligibility Criteria For Montana Medicaid 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 Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

 Just For You: The easiest way to find the most current Montana Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

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 2024, 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income for a single applicant in Montana in 2024 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 if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Montana Medicaid is a combined $4,000, 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 $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. 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. The income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Montana Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply 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 Nursing Home Medicaid 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 is usually associated with 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 Home and Community Based Services (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 Services (HCBS) Waivers. For a single applicant in 2024, 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Montana for a single applicant is $943/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 2024 asset limit for HCBS Waivers in Montana is a combined $4,000, and the income limit is $943/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $943/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Montana HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply 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 Nursing Home Medicaid 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 Services (HCBS) Waivers through Montana Medicaid is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is normally associated with 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 2024, 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Montana ABD Medicaid for a single applicant is $943/ 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 2024 asset limit for Montana’s ABD Medicaid is a combined $3,000, and the income limit is a combined $1,415/month. This applies to married couples with both spouses applying or with just one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Montana has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirements for Montana’s Aged, Blind, and Disabled (ABD) Medicaid are being disabled, blind or aged (65 or over). For ABD Medicaid applicants who require long-term care 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.

 

How Montana Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many 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 $713,000 (as of 2024) 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 $713,000.

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. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Montana Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Montana and how you can protect your home from it, click here.

 

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 may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

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.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

 Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a Montana Medicaid Nursing Home

After being approved for nursing home coverage through Montana Medicaid, seniors have to choose which Medicaid-accepting nursing home best meets their needs and situation. Even though Montana Medicaid nursing home coverage is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces. Finding the right nursing home can be difficult, especially if you’re looking in a specific location.

Montana has about 60 total nursing homes. That’s not a lot of facilities to cover a lot of ground, but the nursing homes are spread throughout the state. There are seven nursing homes within 25 miles of Billings, but that’s by far the biggest cluster of facilities. Missoula and Great Falls have just three nursing homes each within 25 miles of them, and there are only two around Bozeman.

 TOOLS: To find and compare nursing homes, Montana residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this interactive map from the Montana Department of Public Health and Human services.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. The healthcare professionals who work with you can also be a great source of information. And you can also contact your local Area Agency on Aging to find out more information about nursing homes in Montana.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it help residents with vision and dental care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data reveals that nursing homes in Montana are below the national standards when it comes to fire safety. Montana nursing homes averaged 27.8 fire safety deficiencies that led to citations during a three-year period from 2019-2022, which was more than double the national average of 13.5. This doesn’t mean all Montana nursing homes have fire safety concerns, but some of them definitely do, so you should do your research in this area before making any final decisions.