Montana Medicaid Office

Montana Medicaid office (DPHHS)

Montana runs Medicaid out of the Department of Public Health and Human Services (DPHHS) but splits day-to-day member work across two specialty contractors and two distinct help lines — one for eligibility and case changes, one for medical benefits. Optum operates the public provider directory; Conduent operates the Passport to Health primary-care broker. Knowing which number serves which question saves a call transfer.

Three Montana Healthcare Programs phone lines, three different purposes

Vendor-operated member portals

• Apply or report case changes — apply.mt.gov (DPHHS-operated combined benefits portal).
• Find an enrolled Medicaid provider — Optum runs the public directory at mtdphhs-provider.optum.com.
• Choose a Passport to Health primary care provider — Conduent runs the enrollment broker at mtaccesstohealth.portal.conduent.com.
• Find your local Office of Public Assistance — the OPA locator at dphhs.mt.gov/HCSD/OfficeofPublicAssistance.

DPHHS' member-facing definition of what Medicaid covers is unusually compact and worth repeating: every paid service must be (1) medically necessary, (2) provided by a Montana Medicaid or HMK Plus-enrolled provider, and (3) a Medicaid or HMK Plus-covered service. If any of the three fails, Medicaid does not pay.

Who qualifies for Montana Medicaid?

Montana administers Medicaid and the Children's Health Insurance Program as two brands run by one agency. Adult and family Medicaid is just "Montana Medicaid." Children's coverage uses a tiered name: Healthy Montana Kids Plus (HMK Plus) is the Medicaid-funded coverage track for children, and Healthy Montana Kids (HMK) is the separate CHIP-funded track for kids whose families earn slightly more. Both go through the same Offices of Public Assistance (OPA) eligibility workflow, but live in different funding streams.

Categories Montana Medicaid covers

• Adults age 19 through 64 — Medicaid Expansion under the HELP Act; Montana adopted the expansion in 2015.
• Children under 19 — covered through Medicaid (HMK Plus) or CHIP (HMK), depending on family income.
• Pregnant individuals — pregnancy coverage with 12-month continuous postpartum extension; DPHHS extended postpartum coverage for women on Montana Medicaid and Healthy Montana Kids Programs to 12 months continuous.
• Parents and caretaker relatives — state family income standard.
• Aged (65+), blind, or disabled — non-MAGI tracks with both income and resource tests.
• Long-term services and supports — Big Sky Waiver for older adults and adults with physical disabilities and the 0208 waiver for people with developmental disabilities, plus nursing-facility care for members who meet a clinical level-of-care test.

Postpartum extension — what changed

DPHHS extended Medicaid and HMK postpartum coverage to 12 months of continuous coverage. Women who became pregnant or had pregnancy changes since July 1, 2023 have to report those changes to OPA to keep the extended coverage on the books. Three ways to report: the self-service portal at apply.mt.gov, a written statement to the local OPA office, or a call to the Public Assistance Help Line at 1-888-706-1535.

Plain-language eligibility test

Every claim Montana Medicaid pays must clear three tests: the service must be medically necessary, provided by a Montana Medicaid- or HMK Plus-enrolled provider, and a Medicaid- or HMK Plus-covered service. The agency repeats that three-part test verbatim on its member landing page rather than in the dense regulatory language other states use.

Montana Medicaid income standards

DPHHS does not publish a single consumer-facing Montana Medicaid income chart on the MemberServices page. Income standards live in the Montana Healthcare Programs Member Guide PDF (currently the 1/1/2026 edition) and in the OPA caseworker handbook. Federal poverty level updates each January; the percentages of FPL Montana applies stay stable from year to year, so the percentages below are the most reliable summary until the next Member Guide posts.

FPL standards by category

Where to confirm the current dollar figures

Download the latest Montana Healthcare Programs Member Guide PDF from DPHHS, or call the Public Assistance Help Line at 1-888-706-1535 to ask OPA about a category-specific budget. The Member Guide is the document of record for benefit and eligibility rules; check the effective date in the title before quoting figures.

How to apply for Montana Medicaid

Montana funnels every public-benefit application through one portal: apply.mt.gov. The same form screens for SNAP (formerly Food Stamps), TANF cash assistance, Medicaid and Healthy Montana Kids, and LIHEAP heating assistance. Medicaid and HMK applications route to the Offices of Public Assistance (OPA) for an eligibility decision.

Four ways to apply

• Online (recommended) — apply.mt.gov. Create a Sign In/Create Account login to apply, upload documents, and check status.
• By phone — OPA — call the Public Assistance Help Line at 1-888-706-1535 for applications, eligibility questions, and case changes.
• By email — email DPHHS at hhssspapplicationcustomersupport@mt.gov to request an application package.
• On paper, in Spanish — the Spanish-language application is published as DPHHS form HCS250 (revised 01/15/2025) and can be returned to your local OPA office.

Redetermination — the 30-day deadline that matters

DPHHS contacts Medicaid and HMK members about whether they need to complete a redetermination packet to confirm they still qualify. When you receive a packet, you have 30 days to complete it. Miss the deadline and your Medicaid or HMK coverage ends. Return the packet through the apply.mt.gov portal, by mail, or in person at your local Office of Public Assistance.

Keep your contact information current

DPHHS reaches out to members by mail, email, and text message — not just postal mail. Update your contact information at apply.mt.gov (or call 1-888-706-1535) so notices about renewal, redetermination, and case changes actually reach you. A change-of-address form is available through the mt.accessgov.com/dphhs portal.

Federal decision deadlines

Federal rules give DPHHS up to 45 days to decide a non-disability Medicaid application and up to 90 days for applications based on disability. Coverage can be retroactive up to three months before the application month when the applicant had qualifying medical bills during that window.

What Montana Medicaid covers

Montana Medicaid is one of the few state Medicaid programs that does not run on managed care organizations. Instead, DPHHS uses a Passport to Health primary care case management (PCCM) model: every member is paired with a Passport primary care provider who coordinates care and writes referrals. Before you see most other healthcare providers, you need a referral from your Passport PCP — that referral requirement is more strict than the self-refer-to-in-network-specialists default in most MCO-based state Medicaid programs.

Passport to Health PCCM — the rules

• Pick a Passport provider anytime — Conduent runs the enrollment broker at mtaccesstohealth.portal.conduent.com.
• If you don't pick, DPHHS assigns one — every Medicaid and HMK Plus member is enrolled in Passport.
• Most other care requires a Passport referral — without one, the visit may not be covered.
• Help choosing — Medicaid / HMK Plus Member Help Line at 1-800-362-8312, Monday through Friday, 8 a.m. to 5 p.m. Mountain time.

Standard Benefits in Montana Medicaid and HMK Plus

• Doctor, hospital, and emergency services
• Maternity and newborn care
• Prescription drugs
• Laboratory and x-ray services
• Mental health and substance abuse treatment
• Family planning
• Home health services
• Rehabilitative services and supplies
• Speech therapy, audiology, and hearing aids
• Vision care
• Dental care
• Breast pumps
• School-based services
• Non-emergency transportation to appointments (call the Medicaid Transportation Center at 1-800-292-7114)

EPSDT for members under 21

Members under 21 receive Early and Periodic Screening, Diagnostic, and Treatment benefits — the federal mandate that covers any medically necessary preventive, dental, vision, hearing, or behavioral health service for a child, including services that adult Medicaid sometimes does not cover.

Missed appointments

Medicaid providers cannot bill a Montana Medicaid member for a no-show or missed appointment. They can, however, discharge a member from their practice after enough no-shows — provided the practice applies the same no-show policy to its non-Medicaid patients and notifies the Medicaid member that the policy exists.

For full benefit detail

The Montana Healthcare Programs Member Guide PDF (current edition effective 1/1/2026) is the source-of-record for benefit rules, copayments, prior authorization requirements, and the full Passport to Health policy. Download it from the MemberServices page on dphhs.mt.gov.

Other state Medicaid pages