Welcome to Montana Medicaid and Healthy Montana Kids Plus

About Medicaid and Healthy Montana Kids Plus

Montana Medicaid is health care coverage for some low-income adults. Medicaid is run by DPHHS (the Montana Department of Public Health and Human Services).
Healthy Montana Kids Plus (HMK Plus) used to be called children’s Medicaid, before October 1, 2009. HMK Plus is health care coverage for low-income children in Montana and is also run by DPHHS. All medically necessary services are provided to children covered by HMK Plus.
The State of Montana pays about one-third of the cost of Medicaid and HMK Plus and the federal government pays the rest.
The federal government makes basic laws and rules for Medicaid. But no two state Medicaid programs are exactly alike. This means even if you qualified for Medicaid in another state, you would still need to apply in Montana.

Medicaid and HMK Plus Eligibility

To be eligible for Medicaid in Montana, you must meet income and resource limits. You must also fit into at least one of these groups:

• Families with dependent children
• Pregnant women
• Children and youth 18 and under will receive Healthy Montana Kids Plus if eligible (no resource limits)
• Women with breast or cervical cancer or pre-cancer
• People 65 and over

Financial eligibility requirements:

• Resources. For regular Medicaid, total countable resources must be at or below $2,000 for an individual or $3,000 for a married couple. For Medicare Savings Programs, the limit is $6,600 for an individual or $9,910 for a married couple. Many resources are excluded. For example, one vehicle with the highest equity value is excluded. The value of income-producing vehicles may also be excluded. The equity value of all other vehicles is counted toward the resource limit. The applicant’s primary place of residence is excluded. Pre-paid funeral agreements may also be excluded.

A resource assessment is completed when a married person applies for institutional coverage. A resource assessment combines the value of all assets owned by both spouses and allows a portion of that combined value to be retained by the spouse not needing nursing home care. The amount retained varies based on the combined value and minimum and maximum allowances set each year (2009 minimum is $21,912 and maximum is $109,560).

When a person or his or her spouse who is applying for nursing home or waiver Medicaid coverage has transferred assets without getting adequate compensation for those assets, the applicant may be penalized and will be ineligible to receive Medicaid benefits for the nursing home or waiver care. Any assets transferred within 60 months of the date the person is both living in a nursing home (or getting waiver services) and applies for Medicaid are evaluated for possible asset transfer penalties.

• Income. There is no true income limit for most Medicaid programs for the aged, blind, or disabled. However, the applicant’s income determines whether the applicant must meet a deductible (also known as an incurment or spend-down amount) before getting Medicaid coverage.

Program descriptions:

• Categorically Needy Medicaid. To be eligible for regular Medicaid with no deductible, an aged, blind, or disabled applicant’s countable monthly income must be equal to or less than

$674 for a single person
$1,011 for a married couple (sometimes even if only one is aged, blind, or disabled)

• Medically Needy Medicaid: If an aged, blind, or disabled applicant’s countable monthly income is greater than the amounts listed above, then the household (either an individual or a couple) will have a monthly deductible equal to the amount of countable income of the household that exceeds $625 per month. The deductible, called an incurment or spend-down, can be met by making cash payments to the State of Montana, incurring medical bills or obligations, or a combination of the two.
• Medicaid for Residents of Nursing Facilities. An aged, blind, or disabled individual living in a nursing facility must have income that is less than the monthly Medicaid payment rate for the facility in which she or he lives. If Medicaid-eligible, a nursing home resident will contribute most of his or her income toward the cost of his or her care in the facility.

However, a nursing home resident is allowed to keep up to $50 a month for personal needs as well as whatever amount is needed to pay health insurance premiums, legally obligated child support and alimony expenses, and, in some cases, an allowance for a spouse living in the community or a home maintenance allowance (for a limited period).

An aged, blind, or disabled person who is married but living in a nursing facility will have his or her income eligibility determined based solely on his or her individual income. He or she may also be allowed to pass some or all of his or her income to the spouse remaining in the community, depending on that spouse’s own income.

• Medicare Savings Programs. The Medicare Savings Programs are limited Medicaid benefits that vary by program.

• A Qualified Medicare Beneficiary pays Medicare Part A (when applicable) and Part B premiums, Medicare deductibles, and Medicare co-payments. Income limits are:

$903 for a single individual
$1,215 for a married couple (even if only one is a Medicare beneficiary)

• A Special Low Income Medicare Beneficiary pays only Medicare Part B premiums. The monthly income ranges are:

$903.01 – $1,083.00 for a single individual
$1,215.01 – $1,457.00 for a married couple (even if only one is a Medicare beneficiary)

• A Qualifying Individual pays only Medicare Part B premiums. The monthly income ranges are:

$1083.01 – $1,219.00 for a single individual
$1,457.01 – $1,640.00 for a married couple (even if only one is a Medicare beneficiary)

Receipt of any Medicaid coverage automatically entitles a Medicare beneficiary to Social Security Extra Help for payment of basic Medicare Part D Prescription Drug Plan premiums. It also limits prescription drug co-payments to $1 to $5 per prescription.

Medicaid does not pay for prescription drugs for those who are getting Medicare benefits or who are eligible for Medicare benefits but refuse to apply for them.

Human & Community Services Division

111 N Jackson Street
(fifth floor of the Arcade Building)
PO Box 202925
Helena MT 59620-2925
(406) 444-1788/(406) 444-5902
Fax (406) 444-2547