Montana Medicaid for Seniors & Long-Term Care

Long-term care Medicaid in Montana uses a different eligibility standard than the MAGI-based rules for the adult expansion group, and Montana's rules differ from the 300% FBR income cap used by many other states. For Institutional/Nursing Home Medicaid, there is no fixed income cap — an applicant's income must simply be less than the cost of nursing home care, with nearly all income above a $50/month personal needs allowance going toward the cost of care. For the Big Sky Waiver (BSW), the income limit is lower: $994/month for a single applicant, equal to 100% of the SSI Federal Benefit Rate for 2026. Asset limits are $2,000 for a single applicant under either pathway. Federal spousal impoverishment rules protect the community spouse's assets.

Montana operates home and community-based services (HCBS) waivers under Section 1915(c) of the Social Security Act. These waivers fund services that allow eligible individuals to receive the level of care they would get in a nursing facility while remaining at home or in a community-based residential setting.

Montana's HCBS programs include the Big Sky Waiver (BSW) for seniors and adults with physical disabilities and a separate HCBS waiver for individuals with developmental disabilities. The Big Sky Waiver currently has a waiting list; the state prioritizes applicants based on need. Functional eligibility must be established through a Level of Care determination by Mountain Pacific Quality Health before waiver services can begin. To make a referral to the Big Sky Waiver, contact Mountain Pacific at (800) 219-7035, or contact Montana DPHHS's Senior and Long Term Care Division at (406) 444-4077 to start the process. As of July 1, 2026, Montana replaced its former Passport to Health primary care case management program with Primary Care Montana (PCMT), which coordinates primary care for Medicaid members.

Montana Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a $50/month personal needs allowance. Unlike income-cap states, Montana does not impose a fixed income ceiling for Institutional/Nursing Home Medicaid — an applicant's income simply needs to be less than the cost of nursing home care — and it uses a medically needy spend-down approach for cases with high income relative to Medicaid's limits, rather than requiring a "Miller Trust" (qualified income trust).

Montana operates a Medicaid estate recovery program. Per DPHHS, the state may seek reimbursement from the estate of a member who received nursing facility care, HCBS waiver services, or related services at age 55 or older. The family home is generally protected during the lifetime of a surviving spouse or dependent child under 21. Montana follows the federal minimum estate recovery rules and has a 60-month (5-year) lookback period for asset transfers.

When one spouse needs nursing home care, federal law protects the other spouse through the Community Spouse Resource Allowance (CSRA) and a minimum monthly income allowance (MMMNA). Consult a Montana elder law attorney before making asset transfers if a family member may need Medicaid long-term care.

Long-term care Medicaid in Montana covers a range of institutional and home-based services for eligible seniors and adults with disabilities.