Montana Medicaid Eligibility and Enrollment
- How do you know if you're eligible for Montana Medicaid? Learn how you can get Montana Medicaid and how it works for low-income people who need health care.
Medicaid is a great health care resource for low- and zero-income people who can't afford medical care in Montana. Enrollees of all ages have access to a variety of physical, mental and dental health benefits.
Montana Medicaid provides vision care, prescription drugs and dental care for limited or zero out-of-pocket costs for more than 263,000 state residents who are disabled, pregnant, blind or in foster care. Montana Medicaid also covers low-income adults between the ages of 19 and 64 or 65 years of age and older.
What Benefits Does Montana Medicaid Cover?
Montana Medicaid is a division of the Department of Public Health and Human Services, which administers health care benefits for low-income state residents. The department reimburses private and public health care providers for a variety of preventative, primary and acute care services.
Medicaid in Montana provides a plethora of benefits, including audiology, dental and vision care, doctor visits and comprehensive physical exams. It additionally covers hospitalizations, immunizations, labs and X-rays, mental and behavioral health services and wellness checkups.
Medicaid participants in Montana need prior authorization before going to a hospital for medical procedures. All eligible Medicaid enrollees have access to physicians, and Medicaid reimburses for health care services that include routine office visits, X-rays, childbirth procedures, prenatal care and anesthesia. It’s important to note that immunizations in Montana are provided based on the Center for Disease Control's schedule for such procedures.
Montana Medicaid and HMK Plus participants can access health care through the Passport program set up by the state. The Passport program is designed to support Medicaid members, HMK Plus enrollees and health care providers. It is the state’s primary care case management system for ensuring beneficiaries experience the best doctor/patient relationships and receive adequate health care services.
Who Is Eligible for Medicaid in Montana?
Beneficiaries must meet a few federal income and asset guidelines before they can qualify for state Medicaid. A single applicant cannot earn more than $12,760 annually, while the maximum qualifying income for a family of four cannot exceed $26,200. Montana Medicaid offers expanded services to cover anyone who earns 138% of the federal poverty level. However, it requires those members to pay up to 3% of their quarterly income in co-pays.
Pregnant women qualify with incomes as high as 157% of the federal poverty level — or $1,539 per month. Blind and disabled people can qualify with assets worth up to $2,000 for individuals and $3,000 for a couple, and with incomes up to $735 for individuals and $1,103 for couples, per month.
Children in Montana are eligible for Healthy Montana Kids Plus (HMK Plus) as part of the Children’s Health Insurance Program (CHIP), which provides medically necessary coverage for children until their 19th birthday where families have insufficient financial resources to pay for it. Families can earn up to 143% of the federal poverty level. Babies born to women who are receiving Medicaid at the time of the child’s birth automatically qualify for Medicaid coverage until their first birthday.
Montana Medicaid provides sliding scale health care coverage for people with disabilities. The beneficiaries must be employed — either through an employer or self-employed — and earning $15,000 or less for an individual or $30,000 or less for a couple per year.
How Do I Enroll in Medicaid in Montana?
It's easy to learn if you qualify for Medicaid in Montana, and once you determine if you're eligible, you can enroll in several ways. Applications are available online through the Montana Medicaid web portal. The website allows you to sign up, create an account and explore benefits. Individuals can apply for Montana Medicaid or HMK Plus/CHIP by phone at (888) 706-1535.
You can also submit your application via fax to (877) 418-4533 or mail it to the Montana Department of Public Health and Human Services.
Contact Information for Montana Medicaid
The main office for Medicaid is located at the Montana Department of Public Health and Human Services in Helena. You can contact the office’s switchboard by calling (888) 706-1535. General correspondence, questions and paper applications can be sent to the state Medicaid office at:
Montana Department of Public Health and Human Services
PO Box 202925
Helena, MT 59602