Montana Medicaid Income Limits 2026: Long-Term Care Eligibility

The 2026 Financial Thresholds

Montana's long-term care Medicaid program uses two separate tests: an income test and an asset test. Both must be satisfied before the state covers nursing home or memory care costs.

For a single applicant in 2026, the numbers are:

• Income cap: $994 per month (pegged to 100% of the SSI Federal Benefit Rate)
• Countable asset limit: $2,000

That income cap looks impossibly low — most retirees with Social Security and a pension blow past it. But Montana handles over-income applicants differently than most states, and that difference matters.

Montana's Medically Needy Spend-Down

Unlike the 35+ states that require a Miller Trust (Qualified Income Trust) when income exceeds the cap, Montana is a "medically needy" jurisdiction. Over-income applicants qualify by spending their excess monthly income directly on medical and care costs until their remaining income falls to the Medically Needy Income Limit (MNIL) of $525 per month.

A $120 standard income disregard applies first, setting the effective spend-down floor at $645.

Here's what that looks like in practice: if your parent receives $2,200 per month in Social Security and pension income, they spend the difference between $2,200 and $645 — roughly $1,555 — on facility costs and medical bills each month. Once those bills absorb the excess, Medicaid covers the remaining balance.

No trust paperwork. No attorney fees for trust administration. The spend-down happens on paper each month when you report care expenses to the Office of Public Assistance.

What Counts as an Asset (and What Doesn't)

The $2,000 asset limit applies to countable resources — bank accounts, investments, cash value life insurance above $1,500, and non-exempt property. Several categories are excluded:

• The primary home (up to $752,000 in equity, with no cap if a spouse or minor/disabled child lives there)
• One vehicle
• Household furnishings and personal effects
• Irrevocable burial trusts (prepaid funeral plans up to about $5,000)
• Term life insurance (no cash value)

The home exemption is the biggest lever. A parent's house stays exempt as long as they express an "intent to return" — even if that return is medically unlikely. But the home isn't permanently protected: Montana's expanded estate recovery laws under MCA § 53-6-167 can reach it after death, including through non-probate transfer mechanisms like joint tenancy and transfer-on-death deeds.

Married Couples Get Spousal Protections

When one spouse needs facility care and the other remains at home, Montana follows federal spousal impoverishment rules. The at-home spouse keeps:

• Community Spouse Resource Allowance (CSRA): Between $32,532 and $162,660 of the couple's combined countable assets
• Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,705 per month in protected income, rising to $4,066.50 with documented excess shelter costs

The CSRA is calculated at the time of continuous institutionalization. Half the couple's total countable assets at that point becomes the CSRA, subject to the floor and ceiling.

The Application Process

Applications go through the local Office of Public Assistance (OPA), either online at apply.mt.gov or on paper at the county office. The state has 45 days to decide age-based applications and up to 90 days for disability-based ones.

Before applying, the applicant also needs a clinical screening. Mountain Pacific Quality Health (MPQH) conducts a Level of Care assessment to determine whether the applicant meets the Nursing Facility Level of Care (NFLOC) standard — a functional test, separate from the financial one. Both must pass.

The financial application and the clinical screening run through different offices (OPA handles money, MPQH handles function), so start both simultaneously. Families who submit financial applications without requesting the clinical screening — or vice versa — face weeks of unnecessary delay.

Planning Ahead

The 60-month look-back period means asset transfers made within five years of the application date trigger penalty periods. The state divides the value of uncompensated transfers by $322.27 (the 2026 daily penalty divisor) to calculate how many days of Medicaid ineligibility the applicant faces.

Starting the financial documentation process 3–6 months before you expect to apply gives time to identify and resolve accidental transfers — a birthday check to a grandchild, a car gifted to a family member — that could trigger penalties.

The Montana Dementia & Memory Care Guide walks through each financial threshold with worksheets for tracking assets, calculating spend-down amounts, and documenting the look-back period before you file.

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