Montana Medicaid for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex
Montana Medicaid long-term care has separate eligibility rules from standard Medicaid
What Montana Medicaid covers for seniors
Montana Medicaid covers nursing facility care, home health services, and a range of home and community-based services through HCBS waiver programs for eligible seniors and adults with disabilities. Montana operates multiple 1915(c) HCBS waivers designed to support people who need nursing-level care but prefer to remain at home or in a community setting.
- Skilled nursing facility (nursing home) care
- Home health aide services
- Personal care services at home
- Adult Day Health services
- Homemaker services
- Respite care for family caregivers
- Home modifications and assistive technology (through HCBS waivers)
- Hospice care
- Non-emergency medical transportation
- Case management and care coordination
Source: Montana DPHHS Senior and Long Term Care Division; Montana Medicaid HCBS waiver program descriptions.
Financial eligibility for Montana Medicaid long-term care
Long-term care Medicaid in Montana uses a different eligibility standard than the MAGI-based rules for the adult expansion group. The income limit for nursing facility care is 300% of the SSI Federal Benefit Rate. Asset limits are $2,000 for a single applicant. Federal spousal impoverishment rules protect the community spouse's assets.
| Financial figure | Approximate amount (2026) |
|---|---|
| Income limit (300% SSI FBR) | ~$2,901/mo |
| Individual asset limit | $2,000 |
| Community spouse minimum resource protection | ~$30,828 (2026 federal floor) |
| Community spouse maximum resource protection | ~$154,140 (2026 federal cap) |
Source: Federal SSI FBR 2026; federal spousal impoverishment rules (42 U.S.C. § 1396r-5). Contact Montana DPHHS for state-specific figures — Montana may set its community spouse protection at the federal floor or ceiling. Verify with DPHHS or a Montana elder law attorney.
Montana HCBS waivers: home-based alternatives to nursing facilities
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 Aging Waiver for seniors and the HCBS-DD waiver for individuals with developmental disabilities. Waiver programs often have waiting lists — functional eligibility must be established through a DPHHS assessment before waiver services can begin. Contact the Aging Services Division at 1-800-332-2272 to start the process.
Montana also operates the Passport to Health program for some Medicaid members — a case management program that helps coordinate care for individuals with complex health needs across medical, behavioral health, and long-term care services.
Montana Medicaid estate recovery
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. Consult a Montana elder law attorney before making asset transfers if a family member may need Medicaid long-term care — Montana has a 60-month (5-year) lookback period for asset transfers.
Medicaid as the primary payer for long-term care
Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.
Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Montana's share of that population is administered through Montana Medicaid. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.
Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.
Nursing facility coverage
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 personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.
If income exceeds the institutional Medicaid limit, Montana may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Montana uses this approach with Montana Medicaid.
Home and community-based services (HCBS)
HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Montana Medicaid differs from what's available in neighboring states.
Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.
Contact Montana Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.
Asset limits for long-term care Medicaid
Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.
Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.
Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Montana Medicaid or a Medicaid planning attorney before transferring assets.
Spousal protections
When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.
The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Montana's current CSRA is set by Montana Medicaid and published on their website.
The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).
Estate recovery applies to long-term care recipients age 55 and older
What long-term care Medicaid typically covers
- Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
- Physical, occupational, and speech therapy provided in a nursing home
- Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
- Home health aide visits for those receiving care at home
- Adult day health care programs
- Respite care to give family caregivers temporary relief
- Durable medical equipment prescribed by a physician
- Transportation to and from medical appointments