Montana Medicaid

Updated August 2026

Montana Medicaid is administered by the Montana Department of Public Health and Human Services (DPHHS), operating as the Montana Healthcare Programs division. Montana expanded Medicaid under the ACA through the HELP Act — the Health and Economic Livelihood Partnership Act — passed by the Montana Legislature in 2015 and effective January 1, 2016. Montana was one of the later expansion states, and the HELP Act included work requirement elements that were ultimately not enforced after federal guidance changed.

Federal changes to Montana Medicaid are being implemented in 2025 and 2026

H.R. 1 (signed July 4, 2025) introduced new federal Medicaid requirements. Montana DPHHS is implementing these changes. Visit dphhs.mt.gov for the latest information on program changes affecting current members.

What is Montana Medicaid?

As of 2025, approximately 280,000 Montanans are enrolled in Montana Medicaid. The program uses a mix of managed care and fee-for-service. Montana operates a primary care case management (PCCM) model in some areas, where members choose a primary care provider who coordinates their care within fee-for-service Medicaid.

Montana Medicaid covers doctor visits, hospital care, prescriptions, behavioral health, long-term care, and limited dental for adults. Children receive comprehensive benefits including full dental coverage.

Who qualifies for Montana Medicaid?

Income limits vary by coverage category. The HELP Act expansion covers adults 19–64 at or below 138% FPL. Children qualify at higher income levels under Healthy Montana Kids.

Adults ages 19–64 (HELP Act expansion): at or below 138% FPL — approximately $20,783/year for a single person in 2026
Children under age 19: up to 261% FPL through Medicaid or Healthy Montana Kids CHIP
Pregnant women: up to 158% FPL
Seniors and people with disabilities: income and asset rules vary — contact DPHHS
Parents and caretaker relatives: income limits vary based on household composition
Medicare Savings Programs: help low-income Medicare beneficiaries pay premiums

Source: Montana DPHHS Montana Healthcare Programs. Verify current limits at dphhs.mt.gov or by calling 1-800-362-8312.

How Montana Medicaid is delivered

Montana uses a predominantly fee-for-service delivery model. Members can see any Montana Medicaid-enrolled provider without a referral in most cases. Montana does not operate a statewide managed care program for general Medicaid; instead, DPHHS contracts with providers directly and reimburses under a fee-for-service schedule.

For behavioral health services, Montana has moved toward managed behavioral health care through contracted entities. Long-term care services — including nursing facility care and home-based waiver programs — are managed through DPHHS's Aging Services Division and Disability Services Division.

Members apply and manage their benefits through the Montana Healthcare Programs portal. The application portal is at medicaidprovider.mt.gov for providers, and applications for benefits are handled through DPHHS local offices or by calling 1-800-362-8312.

Healthy Montana Kids: CHIP coverage for children

Healthy Montana Kids covers children up to 261% FPL whose family income is above the standard Medicaid threshold. It is administered through DPHHS and uses the same application process as Montana Medicaid. Children at lower income levels qualify for Medicaid; children in the gap between Medicaid and 261% FPL qualify for Healthy Montana Kids CHIP. Both programs provide comprehensive pediatric coverage.

Finding a Montana Medicaid provider

Because Montana Medicaid runs largely fee-for-service, most members are not assigned to a plan network — you can see any provider currently enrolled in Montana Medicaid, and there is no statewide public online provider-lookup tool for members to search on their own. The most reliable way to confirm a specific doctor accepts Montana Medicaid is to ask the practice directly before scheduling.

For help locating a participating provider, call the Montana Healthcare Programs Member Help Line at 1-800-362-8312 (Monday–Friday, 8 a.m.–5 p.m.). Members in behavioral health managed care or an HCBS waiver should check with their care coordinator, since those services route through separate contracted networks rather than standard fee-for-service.