Qualifications for Medicaid in Montana

Medicaid eligibility requirements for Montana Medicaid and Healthy Montana Kids (HMK) expanded under state legislation. Approximately 47,000 beneficiaries met the Medicaid benefits eligibility requirements in the first seven months of expansion and the uninsured rate dropped by 36 percent between 2013 and 2015.

What are the requirements for Medicaid, considering that Montana has accepted the expansion? Montana has saved money as a result of expansion and with an estimated 70,000 recipients being newly eligible for coverage, potential beneficiaries are curious about how to qualify for Medicaid in MT. However, requirements remain the same. The two main considerations for Medicaid involve household income and citizenship status.

Reports from the state show how $75 million has been funneled into healthcare for state residents who meet Medicaid eligibility, fully funded by the government. This leaves young adults, adults and pensioners asking the question, “What are the Medicaid application guidelines?”

Discover how to qualify for Medicaid with the following information:

  • Financial Medicaid eligibility requirements in Montana
  • Non-Financial Medicaid eligibility requirements in Montana
  • Understanding the Medically Needy Program in Montana
  • How the Medicaid Expansion has affected the economy in Montana
  • Effective date of Medicaid coverage in Montana

Financial Medicaid Eligibility Requirements in Montana

“How does Montana determine who is eligible for Medicaid?” Adults, pregnant women and children are on the list of who is eligible. But what are the income requirements for Medicaid?” Under the latest guidelines, approximately 70,000 of Montana’s residents are newly eligible for coverage. These beneficiaries will be those earning the lowest income in the state.

Proof of income must be provided to the Medicaid agency in Montana, so that the agency’s workers can ascertain whether the applicant is someone who is eligible for Medicaid. MAGI-based income counting rules apply in most cases, but may not apply when assessing Medicaid requirements for disabled or blind beneficiaries.

“What are the requirements for Medicaid?” Meeting Medicaid eligibility coverage saves the recipient more money long-term compared to enrolling in subsidy healthcare. Because of the expansion, 40,140 beneficiaries were able to avoid the coverage gap and meet the application guidelines for Medicaid.

For financial eligibility to be properly understood by the person(s) reviewing applications for Medicare in MT, an asset and resource test will usually commence.

Recipients who meet the following annual income Medicaid eligibility requirements will be covered:

  • $15,800 for households with one person
  • $21,307 for households with two people
  • $26,813 for households with three people
  • $32,319 for households with four people
  • $37,825 for households with five people
  • $43,331 for households with six people
  • $48,851 for households with seven people
  • $54,384 for households with eight people

Copayments may be owed for received Medicaid benefits, but payment will not be due until claims are processed.Providers who participate in Medicaid will be billed automatically.

When Medicaid is the secondary payer, copayments will not be necessary. For accurate guidelines regarding how to qualify for Medicaid, managing agencies in Montana must be contacted.

Non-Financial Medicaid Eligibility Requirements in Montana

The streamlined Medicaid benefits system focuses on non-financial guidelines, as well as financial guidelines. Non-financial eligibility criteria applies in some cases, and for a recipient to know how to qualify for Medicaid in Montana, he or she must be a state resident. Alternatively, he or she must be a lawful permanent resident to match the Medicaid application guidelines. Parenting status, pregnancy or age may hinder an applicant’s process in particular eligibility groups.

Case workers will request to see certain documents, so as to satisfy the covered group’s Medicaid requirements. Social Security numbers (SSNs) for the applicant and any children who want to enroll must be provided, as well as proof of Montana residency, proof of U.S. citizenship and sometimes, parenting status will need to be presented to the person overseeing the Medicaid application.

Understanding the Medically Needy Program in Montana

The state of Montana can launch a “Medically Needy Program” if an applicant is in ill health, but earns too much money to match the Medicaid qualifications. As income grows, meeting the Medicaid eligibility requirements in MT can prove difficult. The Medically Needy Program works by “spending down”.

What are the Medicaid application guidelines for spending down? To put it simply, the beneficiary must afford remedial and medical services to the standard income amount in Montana. The “spend-down” amount is then funded by Medicaid. Monthly medical bills must be investigated ahead of approval.

How the Medicaid Expansion has affected the economy in Montana

In Montana, the coverage gap is shrinking and the number of people learning how to qualify for Montana Medicaid is growing. Enrollment as of July 2016 stood at 47,399, which is almost double the primary projection of 25,000 enrollees.

The state health department has announced how $5.3 million has been saved by transferring coverage from traditional Medicaid to the expansion. Thus far, $1.1 million has accumulated in Medicaid premiums, with the typical premium price fixed at $26 for beneficiaries who meet the Montana Medicaid eligibility requirements.

Effective Date of Medicaid Coverage in Montana

Coverage can be obtained three months prior to applying for Medicaid in some cases. Generally, coverage will be effective on the first day of the month in which the beneficiary applied. When Medicaid eligibility requirements in Montana are no longer met, coverage will stop. To ensure unnecessary payments are not made by the healthcare recipient, Medicaid will first check the Evidence of Coverage.