Montana Medicaid & Elder Care
Montana's senior Medicaid landscape offers the Big Sky Waiver for home and community-based care, alongside entitlement programs like Community First Choice, supporting independent living for those meeting nursing home level of care.
Medicaid Report Card
Overall State Performance Index
Based on CMS Nursing Home Compare + state Medicaid agency data
View Methodology arrow_forwardMontana Monthly Costs
Montana's assisted living costs are approximately 8% lower than the national median, while nursing home costs, based on 2024 data, are also likely below the 2026 national average.
Waiver Programs
Montana Big Sky Waiver Program
Also called: HCBS Waiver, Elderly/Physically Disabled Waiver, Medicaid Home and Community Based Services (HCBS) Waiver
The Big Sky Waiver provides home and community-based services for seniors and individuals with physical disabilities who require a Nursing Home Level of Care but choose to live in their home, a loved one's home, or an assisted living facility. It offers a range of services to prevent institutionalization.
- check_circle Adult Day Health
- check_circle Adult Residential Living
- check_circle Audiology
- check_circle Case Management
- check_circle Chemical Dependency Counseling
- check_circle Community Adult Group Homes
- check_circle Community Transition
- check_circle Consultative Clinical and Therapeutic Services
- check_circle Consumer Directed Goods and Services
- check_circle Dietetic-Nutritionist Services
- check_circle Environmental Adaptations
- check_circle Family Training and Support
- check_circle Financial Management Services - Self Direction
- check_circle Habilitation Services
- check_circle Health and Wellness
- check_circle Homemaker Services
- check_circle Homemaker Chore
- check_circle Independence Advisor - Self Direction
- check_circle Level 1 Assisted Living
- check_circle Level 2 Assisted Living Behavioral Health Modification
- check_circle Level 3 Assisted Living Specialized Care
- check_circle Member Directed Goods and Services
- check_circle Money Management
- check_circle Non-Medical Transportation
- check_circle Nurse Supervision for Personal Care Attendants
- check_circle Nutrition
- check_circle Occupational Therapy
- check_circle Pain and Symptom Management
- check_circle Personal Assistance
- check_circle Personal Emergency Response Systems (PERS)
- check_circle Physical Therapy
- check_circle Post Acute Rehabilitation Services
- check_circle Prevocational Services
- check_circle Private Duty Nursing
- check_circle Psychosocial Consultation
- check_circle Respiratory Therapy
- check_circle Respite Care
- check_circle Senior Companion
- check_circle Service Animals
- check_circle Skilled Nursing
- check_circle Specialized Child Care for Medically Fragile Children
- check_circle Specialized Medical Equipment and Supplies
- check_circle Specially Trained Attendant
- check_circle Speech Therapy
- check_circle Supported Employment
- check_circle Supported Living
- check_circle Vehicle Modifications
warning Waitlist Alert
The Big Sky Waiver is not an entitlement program and has a waitlist. Individuals are not offered slots on a first-come, first-served basis; instead, openings are offered to those with the most need and likelihood to benefit.
2026 Eligibility Requirements
| Criteria | Individual Limit | Married (Both Applying) |
|---|---|---|
| Monthly Income | $994 | $1,988 |
| Asset Limit | $2,000 | $4,000 |
| Home Equity Limit | $752,000 | |
| Level of Care | Nursing Home Level of Care (NHLOC) | |
Estate Recovery Warning
Montana's Medicaid Estate Recovery Program actively seeks reimbursement for long-term care costs from a deceased recipient's estate, including placing liens on real property. Recovery is deferred under specific circumstances involving surviving spouses or dependent children, and hardship waivers can be requested.
Spend-Down & Asset Protection
PROTECTED ASSETS
COMMON PITFALLS
- warning Look-back Period: Gifts or transfers for less than fair market value made within 60 months prior to application trigger penalties.
- warning Excess Income: Failing to utilize the Medically Needy spend-down program if income exceeds the cap.
- warning Joint Accounts: The full balance of jointly owned assets is often counted towards the applicant's asset limit.
First Steps for Families
Locate your ADRC
Contact your local Montana Aging and Disability Resource Center.
Gather 5 years of records
Bank statements, deeds, asset transfers for the Medicaid look-back period.
Financial assessment
Consult a Medicaid planner if assets exceed $2,000.
Resource Contact
Montana Department of Public Health and Human Services, Senior and Long Term Care Division
How to Apply for Montana Long-Term Care Medicaid
Assess Level of Care
Contact Mountain Pacific Quality Health at (800) 219-7035 to initiate the functional needs assessment for Nursing Home Level of Care.
Gather Records
Collect financial statements, income verification, property deeds, and medical records for the application.
Submit Application
Apply online at apply.mt.gov, by phone at (888) 706-1535, or in person at a local Office of Public Assistance.
Eligibility Investigation
The agency will conduct an investigation to determine eligibility, which may include interviews and gathering additional information.
Approval & Care
If approved, Medicaid coverage begins on the first day of the month the application was submitted.
Documents You'll Need
Financial Verification
- Bank statements (5 years)
- Stock/bond certificates
- Retirement account information
- Value of trusts
- Value of burial policies
- Amount of loans, gifts or contributions
- Balance of individual Indian money account
Income Verification
- Pay stubs
- Social Security award letters
- Pension statements
- VA benefit statements
- Self-employment financial records
- W2 forms
Medical/Identity
- Social Security card
- Medicare card
- Health care policies
- Life insurance policies
- Doctor's clinical assessments
Property/Residency
- Home deed
- Vehicle registration
- Proof of Montana residency
- Car/mobile home/house information
Frequently Asked Questions About Montana Medicaid
Does Montana Medicaid pay for assisted living?
Yes, Montana Medicaid's Big Sky Waiver Program can help cover the cost of services in assisted living facilities for eligible seniors who require a Nursing Home Level of Care. However, the waiver does not cover room and board costs in these facilities.
What is the Montana Medicaid income limit for seniors in 2026?
For 2026, a single senior applying for Montana's HCBS Big Sky Waiver has an income limit of $994 per month. For married couples, the combined income limit is $1,988 per month. Montana also has a Medically Needy pathway allowing individuals with higher income to 'spend down' on medical expenses to qualify.
How long is the HCBS waiver waitlist in Montana?
The Montana Big Sky Waiver Program has a waitlist, as it is not an entitlement program. The average wait time has been reported as approximately 125 days, though wait times can vary from months to years. As of recent data, around 2,500 individuals are on the waitlist.
Will Medicaid take my parent's house in Montana?
Montana's Medicaid Estate Recovery Program may place a lien on a deceased recipient's home to recover long-term care costs. However, recovery is deferred if a surviving spouse, a child under 21, or a blind or permanently disabled child of any age resides in the home. Hardship waivers are also available.
Can I be paid to care for my parent through Montana Medicaid?
Yes, Montana Medicaid offers programs that allow for paid family caregivers. Through the Big Sky Waiver and the Community First Choice / Personal Assistance Services (CFC/PAS) Programs, eligible participants can self-direct their care and hire family members, such as adult children, to provide personal care services. Spouses can sometimes be hired under the Big Sky Waiver, but not typically under CFC/PAS.
Medicaid vs Medicare for long-term care in Montana?
Medicare primarily covers acute medical care and limited short-term skilled nursing or rehabilitation, not ongoing long-term care. Montana Medicaid, conversely, is the primary payer for extensive long-term care services, including nursing home care and home and community-based services through programs like the Big Sky Waiver and CFC/PAS, for financially eligible seniors.
TOPICAL GUIDES — HOW MEDICAID WORKS
EXPLORE MONTANA
Last updated: April 24, 2026. Sources: Montana Department of Public Health and Human Services, Senior and Long Term Care Division, CMS Nursing Home Compare, Genworth 2024 Cost of Care Survey. Eligibility rules are set by each state Medicaid agency and update annually. We cite the agency name, statute, or CMS data source for every figure on this page; see our methodology and editor.