This guide provides comprehensive information about Medicaid eligibility in Montana. Whether you're a child, parent, pregnant woman, or adult, this guide will help you understand if you qualify for Montana Medicaid coverage and how to apply.

Montana has expanded Medicaid under the Affordable Care Act (ACA), which means most adults with income up to 138% of the Federal Poverty Level (FPL) can qualify for Medicaid. This expansion has significantly increased access to healthcare coverage. In expansion states like Montana, there is generally no asset test for MAGI-based Medicaid programs (those for children, pregnant women, parents, and other adults under 65).

Important Note: Medicaid eligibility rules and income limits are subject to change. For the most up-to-date information, please contact the Montana Medicaid office at 1-888-706-1535 or visit dphhs.mt.gov/MontanaHealthcarePrograms/MemberServices.

General Eligibility Requirements

To qualify for Montana Medicaid, you must:

Be a resident of Montana
Be a U.S. citizen or have qualified immigration status
Have or apply for a Social Security number (with some exceptions)
Meet the specific eligibility criteria for at least one Medicaid pathway
Meet income guidelines (which vary by program)

Note: This guide covers the main Medicaid eligibility categories for children, pregnant women, parents, and adults. Additional pathways exist for seniors (65+), people with disabilities, and those with specific medical conditions. These specialized programs often have different income and asset requirements not detailed in this guide.

Medicaid Eligibility Pathways in Montana

Montana offers several pathways to Medicaid eligibility, each with specific requirements. Please note, a 5% income disregard may already be included or can be applied depending on circumstances.

1. Medicaid for Children

Who Qualifies:

Children under age 19
Montana residents
U.S. citizens or those with qualified immigration status
Meeting income guidelines

Income Limits:

Children (0-18): Up to 143% FPL

Family Size	Children (0-18) (143% FPL)
1	$1,865
2	$2,521
3	$3,176
4	$3,831
5	$4,487
6	$5,142
7	$5,797
8	$6,454
Each Additional Person	+$655

2. Children's Health Insurance Program (CHIP)

Who Qualifies:

Children under age 19
Family income above Medicaid limits but at or below 261% FPL
Montana residents
U.S. citizens or those with qualified immigration status
No other insurance coverage

Income Limits:

Above Medicaid limits up to 261% FPL

3. Medicaid for Pregnant Women

Who Qualifies:

Pregnant individuals
Montana residents
U.S. citizens or those with qualified immigration status
Meeting income guidelines

Income Limits: 162% of FPL

Family Size*	Monthly Income Limit	Annual Income Limit
2	$2,856	$34,272
3	$3,598	$43,176
4	$4,340	$52,080
5	$5,084	$61,008
6	$5,826	$69,912
7	$6,567	$78,804
8	$7,311	$87,732
Each Additional Person	+$742	+$8,904

*Note: Unborn child is counted as a family member when determining family size.

Important: Coverage extends for 12 months postpartum in Montana.

Presumptive Eligibility: Temporary coverage for outpatient prenatal services while the full application is being processed.

4. Medicaid for Adults

Who Qualifies:

Adults ages 19-64
Not eligible for Medicare
Montana residents
U.S. citizens or those with qualified immigration status
Meeting income guidelines

Income Limits: 138% of FPL

Family Size	Monthly Income Limit	Annual Income Limit
1	$1,800	$21,600
2	$2,433	$29,196
3	$3,065	$36,780
4	$3,697	$44,364
5	$4,330	$51,960
6	$4,962	$59,544
7	$5,595	$67,140
8	$6,228	$74,736
Each Additional Person	+$632	+$7,584

5. Medicaid for Parents & Caretaker Relatives

Who Qualifies:

Parents or caretaker relatives of dependent children under age 19
Must live with and provide care for the child
Montana residents
U.S. citizens or those with qualified immigration status
Meeting income guidelines

Income Limits: 143% of FPL

Family Size	Monthly Income Limit	Annual Income Limit
2	$2,521	$30,252
3	$3,176	$38,112
4	$3,831	$45,972
5	$4,487	$53,844
6	$5,142	$61,704
7	$5,797	$69,564
8	$6,454	$77,448
Each Additional Person	+$655	+$7,860

6. Medically Needy Program

The Medically Needy program helps people with high medical expenses who might not otherwise qualify for Medicaid due to income or resources that are too high. Through this program, individuals can 'spend down' their income on medical expenses to reach the program's eligibility threshold.

How Income is Counted for MAGI-based Healthcare Programs

Understanding how your income is counted is important for determining eligibility for Medicaid and other healthcare programs. Medicaid income limits are based on MAGI (Modified Adjusted Gross Income). To learn how MAGI income is calculated see: How Income is Counted for MAGI

How to Apply for Montana Medicaid

There are several ways to apply for Medicaid in Montana:

Online: Visit dphhs.mt.gov/MontanaHealthcarePrograms/MemberServices
By Phone: Call 1-888-706-1535
In Person: Visit your local Department of Social Services or Medicaid office
By Mail: Request a paper application from your local Medicaid office

Affordable Care Act (ACA) Coverage

If you don't qualify for Medicaid in Montana, you may be eligible for subsidized health insurance through the Health Insurance Marketplace.

Who Can Apply for Marketplace Coverage

Anyone who:

Lives in the United States
Is a U.S. citizen or national (or is lawfully present)
Is not incarcerated
Is not covered by Medicare

Premium Tax Credits and Subsidies

Premium tax credits help reduce your monthly insurance premiums. In Montana (a non-Medicaid expansion state), you may qualify for premium tax credits if your income is between 100% and 400% of the Federal Poverty Level, and in some cases above 400% FPL.

Family Size	Monthly Income at 400% FPL	Annual Income at 400% FPL
1	$5,216	$62,592
2	$7,052	$84,624
3	$8,884	$106,608
4	$10,716	$128,592
5	$12,552	$150,624
6	$14,384	$172,608
7	$16,216	$194,592
8	$18,052	$216,624
Each Additional Person	+$1,832	+$21,984

When to Apply

During the annual Open Enrollment Period (typically November to January)
Within 60 days of certain life events that qualify for a Special Enrollment Period (losing other coverage, marriage, birth of a child, etc.)

How to Apply for Marketplace Coverage

Visit Healthcare.gov
Call the Marketplace Call Center at 1-800-318-2596
Get in-person help from a Navigator or Certified Application Counselor (find local assistance at Healthcare.gov)

What You'll Need to Apply

Social Security numbers for everyone on your application
Employer and income information for everyone in your household
Current insurance information (if applicable)
Immigration documentation (if applicable)

Disclaimer

This guide provides general information about Montana Medicaid eligibility based on data available as of March 2025. Eligibility criteria, income limits, and application procedures may change. Always consult the official Montana Medicaid website or call the Montana Medicaid Recipient Call Center at 1-888-706-1535 for the most current information.

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