How to Apply for Medicaid in Montana for Nursing Home Care

Three Ways to Submit the Application

Montana accepts Medicaid long-term care applications through three channels:

Online at apply.mt.gov. The state's digital portal walks through the application step by step. Keep the submission confirmation as your filing record — important because Medicaid coverage can be retroactive to the first day of the application month.

By phone at 1-888-706-1535. A representative at the Office of Public Assistance (OPA) can take the application over the phone and tell you exactly which documents to submit afterward.

In person at a regional OPA office. Walk-in applications allow you to ask questions in real time and hand over paper copies of supporting documents.

Regardless of which channel you use, the application itself does not have a filing fee.

Documents You Need Before Starting

The most common reason Medicaid applications stall is missing documentation. DPHHS reviews 60 months of financial history, so the document package is extensive. Gather these before you submit:

Identity and residency. Montana driver's license or state ID, Social Security card, birth certificate, proof of Montana residency (utility bill, lease, or property tax statement).

Income verification. Social Security award letter (SSA-1099), pension statements, any annuity or IRA distribution records, rental income documentation.

Asset documentation — 60 months. Bank statements for every checking, savings, and money market account. Brokerage and investment account statements. Life insurance policies showing cash surrender values. Vehicle titles and registration. Property deeds and mortgage statements. Burial plan or funeral trust documentation.

Medical records. Current diagnoses, medication lists, and the name of the primary care physician. DPHHS coordinates with Mountain Pacific Quality Health (MPQH) for the clinical level-of-care determination separately, but having medical records ready speeds the process.

Legal documents. Power of attorney (if someone is applying on the parent's behalf), guardianship or conservatorship orders if applicable, and any existing trust documents.

Transfer history. Records of any gifts, property transfers, vehicle title changes, or large withdrawals during the past 60 months. Include explanations for any transfer — DPHHS will ask.

The Two-Track Process

A Medicaid long-term care approval requires passing two independent evaluations that can run simultaneously:

Financial eligibility is determined by the local OPA office. They review the application and supporting documents against Montana's thresholds — countable assets under $2,000 for a single applicant, with the medically needy spend-down pathway for income above $994 per month.

Clinical eligibility is determined by MPQH at 1-800-219-7035. They perform a level-of-care assessment evaluating the applicant's functional capabilities — orientation, memory, ambulation, medication management, and behavioral appropriateness. The applicant must need the level of care a nursing facility provides.

Start both tracks at the same time. Financial processing does not need to finish before the clinical assessment, and vice versa.

The 45-Day Processing Window

DPHHS's standard processing window is 45 days. Missing documentation can delay the eligibility determination, so submit the requested records promptly.

Incomplete submissions trigger a request for additional information. Responding promptly is essential; delays in providing requested documents can delay the determination and leave the family paying nursing home costs out of pocket during the gap.

If 45 days pass without a determination, contact OPA to ask about the status. If DPHHS later issues a denial, the applicant can request a fair hearing within 90 days of the written notice.

What Happens After Approval

Once both financial and clinical eligibility are confirmed, Medicaid coverage begins and can be retroactive to the first day of the month the application was filed. This retroactivity can recover thousands of dollars in nursing home costs that accumulated during processing.

The approved applicant receives a Medicaid card and is assigned to either institutional coverage (nursing home) or a home and community-based waiver (Big Sky Waiver), depending on where they are receiving care and whether waiver slots are available.

For nursing home residents, the facility works directly with Medicaid for billing. The resident contributes nearly all monthly income toward care costs, keeping only a $50 personal needs allowance. If there is a spouse at home, spousal impoverishment protections preserve a portion of income and assets for the community spouse.

Form HCS-122 is the estate recovery disclosure. It explains that the state may seek to recover Medicaid costs from the recipient's estate after death — an important detail that families need to understand and plan for.

Annual Redetermination

Medicaid eligibility is not permanent. DPHHS conducts annual redeterminations, requiring updated financial documentation and continued clinical need. Missing a redetermination deadline can result in loss of coverage, so families should calendar the renewal date and prepare documents in advance.

For the complete document checklist, financial worksheets, and step-by-step application walkthrough, the Montana Medicaid Long-Term Care & Asset Protection Guide covers the entire process from initial filing through annual renewal.

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