Medicaid for Senior Care in Montana
What Medicaid Actually Covers for Senior Care
Montana Medicaid offers key support for seniors needing long-term care. For those requiring full-time medical and personal assistance, Nursing Home Medicaid covers the entire cost of care in a certified facility, including room and board. This is an entitlement, guaranteeing benefits if your parent qualifies.
If your parent prefers to stay home or in a community setting like assisted living, the Big Sky Waiver (Montana's Home and Community Based Services Waiver) is the primary option. This program helps cover services such as personal care, homemaker services, skilled nursing, and home modifications to support independent living. Importantly, the Big Sky Waiver does not pay for room and board costs in assisted living or adult foster care. Aged, Blind, and Disabled (ABD) Medicaid with Community First Choice/Personal Assistance Services (CFC/PAS) also offers help with daily activities at home.
Do You Qualify?
Understanding eligibility for 2026 is vital. For a single senior, the countable asset limit is typically $2,000. For married couples where both apply, the limit is $3,000. If only one spouse applies, the applicant is limited to $2,000 in assets, but the non-applicant spouse can keep up to $162,660 as a Community Spouse Resource Allowance.
Income limits vary; for the Big Sky Waiver, a single applicant's limit is $994 per month in 2026, and for married couples, it's $1,988 per month. If income exceeds these limits, Montana's "Medically Needy Pathway" or "Spend-Down" program allows qualification by using excess income for medical bills, acting as a deductible. The Medically Needy Income Limit is $525 per month for single and married applicants in 2026. Your parent's primary residence is usually exempt, especially if a spouse or dependent lives there, or they intend to return, with a home equity limit of $752,000 in 2026. Pension income is counted.
Waitlists & How to Apply
While Nursing Home Medicaid has no waitlists, the Big Sky Waiver is not an entitlement and has limited enrollment slots, so waitlists can occur.
To apply, visit apply.mt.gov online. You can also contact your local Office of Public Assistance (OPA) or call the Montana Public Assistance Helpline at 1-888-706-1535. You'll need documentation on income, assets, medical needs, and residency. A medical assessment confirming a "Nursing Facility Level of Care" is also required. Applications are typically processed within 45 days.
Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.