Montana Medicaid

Last verified: June 2026

What is Montana Medicaid?

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.

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.

Montana Medicaid topics

What does Montana Medicaid cover?

Medicaid covers a broad range of health services. Federal law mandates certain benefits — inpatient and outpatient hospital care, physician services, lab work, X-rays, and nursing facility services, among others. States add optional services on top of those. Dental, vision, and long-term home care coverage vary by state.

The national benefits overview lists required and commonly optional services. Check the Montana Medicaid website for the current state-specific benefit package.

How to apply

Most people can apply online through Montana's Medicaid portal, by phone, or in person at a local eligibility office. The how to apply page walks through each method, what documents you'll need, and what to expect during the review period.

Under 42 CFR 435.912, states must process most standard Medicaid applications within 45 days (90 days for disability-based applications). Montana must follow that federal timeline.