Montana Medicaid Planning: What Families Need to Know

Montana Medicaid can pay for nursing-home care once an unmarried resident's countable resources are at or below $2,000. A spouse at home may keep a share of the couple's resources, up to $162,660 in 2026. Gifts made before applying can trigger a penalty, and the state may seek repayment from the estate after death.

Most people facing a nursing-home admission in Montana arrive at this question suddenly: a parent in Billings has a fall, a husband in Missoula can no longer be cared for at home, and the monthly bill is suddenly larger than the household's income. The family is trying to work out three things at once. Will Medicaid pay? What happens to the house? How will the spouse who stays home live? This page walks through how Montana's own rules answer each of those questions.

How Montana's Medicaid Program Works for Long-Term Care

Montana's Medicaid program is run by the Montana Department of Public Health and Human Services (DPHHS). Its manuals cover nursing-home coverage and home and community-based services (HCBS) waiver coverage. The same eligibility rules apply whether the family lives in Helena, Great Falls or Bozeman.

Federal law sets the framework every state follows, including 42 U.S.C. § 1396p on transfers and estate recovery. Within that framework, Montana runs its own program, with its own limits, forms and appeal deadlines.

A few terms come up again and again:

• A countable asset is property Medicaid counts toward the eligibility limit.
• The community spouse is the husband or wife who stays at home while the other spouse receives institutional care.

Nursing-home and waiver coverage. Several of the rules on this page reach HCBS waiver clients as well as nursing-home residents. The home-equity limit described below applies to both nursing-home and waiver benefits, and the transfer penalty in CMA 404-2 applies to both waiver and institutionalized clients. A penalty bars Medicaid payment for waiver or institutional services, but the person may still qualify for other services during that time.

This page covers Medicaid for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.

Montana Medicaid Eligibility: Asset Limits and What Counts

DPHHS sets the resource standard for an unmarried nursing-home resident at $2,000. The general limit for an institutionalized spouse is also $2,000, according to CMA 001, General Resource Limits. Resources above the standard disqualify the applicant. However, a person who is resource-eligible on any day of a month is treated as eligible for the whole month.

What counts. Countable assets generally include bank accounts, investments and real estate other than the home.

What is excluded. CMA 402-1 lists the exclusions. They include:

• The home and the land surrounding it. Land separated from the home by a road or other right-of-way is counted.
• One vehicle used as a home.
• A newly purchased home the owner will move into within 30 days.

A home located outside Montana is counted.

The home-equity limit. Federal law, 42 U.S.C. § 1396p(f), bars long-term-care coverage above a home-equity limit unless a spouse, a child under 21 or a blind or disabled child lives in the home. Montana's limit is $752,000, effective January 1, 2026. It does not apply if a community spouse or a minor or disabled child lawfully lives in the home.

Income Rules, Including Residents With Higher Incomes

Under ABD 013, an otherwise eligible resident is income-eligible for nursing-home coverage as long as monthly nursing-home costs equal or exceed monthly income. Montana's categorically needy income standard for an institutionalized individual is $30 a month. The medically needy income level is $525 a month.

When income is above $525. A resident whose income is above the medically needy level is not shut out for that reason alone. The test in ABD 013 compares income with the cost of care: if monthly nursing-home costs equal or exceed monthly income, the resident can be income-eligible. CMS describes the medically needy pathway in general terms: a person whose income is too high for other groups can become eligible by "spending down", meaning incurring uninsured medical and remedial expenses above the state's medically needy income level. For most nursing-home residents, the monthly cost of care itself is the expense that does this. This page does not address income trusts, such as Qualified Income Trusts, which ABD 013 does not discuss.

After eligibility. Once eligibility is set, DPHHS calculates how much of the resident's income must go toward the cost of care.

Spousal Protections: What the Community Spouse Keeps in Montana

The federal spousal-impoverishment rules, 42 U.S.C. § 1396r-5, set a floor and a ceiling on what a community spouse keeps. When one spouse enters long-term care, the couple's countable resources are added up as of the start of the first continuous period of institutionalization.

Resources the at-home spouse keeps. Federally this is called the Community Spouse Resource Allowance (CSRA): the share of the couple's countable assets the at-home spouse may keep. Montana calls it the community spouse resource maintenance allowance (CSRMA). Effective January 1, 2026, the CSRMA is the greatest of these four amounts, according to CMA 001:

1. One-half of the couple's combined countable resources, but no more than $162,660.
2. The minimum allowance of $32,532.
3. An amount a hearings officer designates.
4. An amount a court orders.

Under CMA 803-1, the resources that make up the CSRMA must be legally transferred to the community spouse within 90 days of Medicaid approval. Both spouses receive notice of the amount, and both may appeal it. A transfer to one's spouse carries no transfer penalty under 42 U.S.C. § 1396p(c)(2)(B)(i).

Income the at-home spouse keeps. Federally, the Minimum Monthly Maintenance Needs Allowance (MMMNA) is the minimum monthly income a community spouse is entitled to keep. The federal minimum changes each July 1, and the federal maximums change each January 1. Montana's figures are in ABD 013. The community spouse income maintenance allowance is the lesser of two amounts:

1. $4,067 (effective January 1, 2026), minus the community spouse's own gross monthly income.
2. Shelter costs above $811, plus a basic needs standard of $2,705 (both effective July 1, 2026), minus the community spouse's own gross income.

Spousal refusal. The DPHHS manual sections cited on this page do not describe a spousal-refusal option, and this page does not address one.

For a spouse in Helena who has shared a household for decades, these figures shape what daily life at home will look like.

Montana's Look-Back Period and Transfer Penalties

The look-back period is the window before a Medicaid application during which transfers of assets are reviewed. Federally, it is 60 months for any transfer made on or after February 8, 2006, under 42 U.S.C. § 1396p(c)(1)(B)(i). CMS describes the same rule as a five-year period before the application. DPHHS's CMA 404-2 states that no penalty can be imposed for assets transferred before the look-back period.

How Montana calculates a penalty. A penalty period is a stretch of time during which Medicaid will not pay for care because assets were given away or sold for less than fair market value. CMA 404-2 says a penalty may apply when a waiver or nursing-home client, or their community spouse, makes such a transfer. To calculate it, DPHHS divides the uncompensated value of the transferred assets by the average daily cost of nursing-home care at the time of the application or the transfer, whichever is later. The average monthly rate DPHHS lists from July 1, 2026, is $10,299.

How the penalty runs. The penalty runs continuously, day by day, whether or not the person stays in the nursing home. During that time the person may still be eligible for other Medicaid services.

When the penalty starts. Federally, a penalty starts on the later of two dates: the month of the transfer, or the date the person is eligible and would otherwise be receiving institutional-level care (42 U.S.C. § 1396p(c)(1)(D)(ii)). This means a gift made four years ago is penalized the same way as a gift made last month, as long as both fall inside the look-back.

Transfers that carry no penalty. Not every transfer is penalized. The federal exceptions include:

• A transfer to the person's spouse.
• A transfer of the spousal resource allowance to the community spouse (42 U.S.C. § 1396r-5(f)(1)).
• Amounts transferred under a court order for the support of a spouse or family member (42 U.S.C. § 1396r-5(f)(3)).

Other federal exceptions exist; this page does not cover how Montana applies them.

Planning Tools Families in Montana Use

Families in Billings, Butte and Great Falls usually encounter the same handful of approaches. Whether any of them fits turns on Montana's manuals and the family's specific facts.

• Spend-down. This means reducing countable assets to the limit by paying for care or other allowed expenses, or by converting countable assets into excluded ones. "Spend-down" also has a separate meaning for income, described in the income section above.
• Irrevocable trusts. CMS states that when an individual, a spouse or someone acting for them sets up a trust with at least some of the individual's funds, the trust can be considered available to the individual when Medicaid decides eligibility. How a particular trust is treated turns on its terms. A trust does not always protect assets.
• Annuities. An annuity converts a lump sum into a stream of income. How Montana treats a given annuity turns on its terms, and an annuity does not always protect assets.
• Life estates. Under CMA 402-1, buying a life estate in another person's home is evaluated as a possible transfer. The penalty can be overcome if the buyer lives on the property as a principal residence for at least one full year after the purchase.

Every asset, transfer and source of income must be reported fully on the application. For more context on time-sensitive situations, see Medicaid crisis planning and this Medicaid crisis planning checklist.

Montana Estate Recovery: What Happens After a Medicaid Recipient Dies

Estate recovery is the process by which the state seeks repayment from a deceased Medicaid recipient's estate for care it paid for.

What Montana recovers. According to DPHHS's CMA 304-4, collection is only pursued for medical expenses Medicaid paid while the individual was:

• a resident of a nursing home or other institution, an intermediate care facility for the mentally retarded, or an institution for mental disease; or
• age 55 or older.

Liens on real property. Liens may be placed on real property owned by nursing-home residents who are not expected to return home.

Required forms. All institutionalized applicants must sign two forms as a condition of eligibility:

• Form HCS-121, "Real Property Liens for Nursing Home Residents."
• Form HCS-120, "Estate Recovery for Nursing Home Residents."

When recovery is deferred. Federally, recovery may be made only after the death of a surviving spouse, and only when no child under 21 and no blind or disabled child survives (42 U.S.C. § 1396p(b)(2)). This deferral postpones the claim; it does not cancel it.

Hardship waivers. States must have procedures to waive recovery when it would cause undue hardship (42 U.S.C. § 1396p(b)(3)). Montana's manual states that recovery will not be pursued if it would cause undue hardship for the heirs. Heirs may also ask the Estate Recovery Unit to waive or compromise recovery based on hardship.

How to Connect with a Montana Medicaid Planning Attorney

A Medicaid planning attorney works through how Montana's rules apply to a family's own assets, income and household. A family in Bozeman and a family in Missoula face the same federal framework and the same Montana manuals. Their outcomes can still differ because their facts differ.

What families typically gather for a first conversation:

• A general picture of assets and income sources.
• The care setting and care needs.
• Any gifts or transfers made in recent years.
• Who lives in the home.

Appeal deadlines. Montana's appeal deadlines are short, as set out in CMA 1505-1:

• Hearing request: must be in writing and received within 90 days of the date the adverse action notice is mailed.
• Ability to pay for institutional care: a hearing request on DPHHS's decision about the person's ability to pay for institutional care must be received within 30 days.
• Board of Public Assistance: an appeal must be received within 15 days of the mailed decision notice. This can be extended to no more than 45 days for good cause.
• District court: an appeal must be filed within 30 days of the Board's final decision.

Continued benefits. Benefits generally continue at the same level until the hearing decision if the hearing request is filed between the date the notice is mailed and the date the adverse action takes effect.

This site provides information and facilitates inquiries. It does not give legal advice. An inquiry may be passed to attorneys, who decide for themselves whether to respond.

Discussing Medicaid Planning in Montana

Montana's figures, the 90-day window for transferring the spousal allowance and the short appeal deadlines all turn on dates. A conversation with an attorney would look at the couple's assets, the timing of any past transfers, the care setting, the home and who lives there. This page does not cover Medicare, private long-term-care insurance or other states' rules.

To discuss a situation like this with an attorney, request a consultation about your family's Medicaid and long-term-care options through Medicaid Asset Protection Group.