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Learn About Requirements for Medicaid in Montana

UPDATE: For 2020, no significant changes were made to Medicaid.

Medicaid eligibility requirements for Montana Medicaid and Healthy Montana Kids (HMK) expanded under state legislation. Hundreds of thousands of recipients qualify for Medicaid in MT. The two main considerations for Medicaid involve household income and citizenship status.

What Are the Financial Medicaid 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?”

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. Explore the different Medicaid requirements by downloading our informative guide.

What Are the Non-Financial Medicaid Requirements in Montana?

The streamlined Medicaid benefits system focuses on non-financial guidelines, as well as financial guidelines. Non-financial eligibility criteria apply 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.

Caseworkers 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.

Learn 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. 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. Download our helpful guide to learn about the different requirements for Medicaid.

When does Medicaid Coverage become effective 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.