Medicaid for nursing home and home care in Montana

Who qualifies

You must:

• Be 65 or older, or blind or disabled.
• Need nursing home level of care. A pre-admission screening is done for both nursing home and waiver services. It is good for 90 days.
• Meet Medicaid's income and asset rules.
• For the Big Sky Waiver, have a need that waiver services can meet, and there must be an open slot.

The income rules

Montana's manual uses two income tests for long-term care.

• Categorically needy. If you get SSI, or your income is low enough, you qualify outright. For nursing home residents, the categorically needy income standard is $30 a month.
• Medically needy (spend down). If your income is higher, you can qualify by having medical bills that bring your income down. The medically needy income level is $525 a month.

How a waiver spend down is figured. DPHHS starts with your income, takes off a $20 general disregard, the medically needy level of $525, and the extra $391 deduction. What is left is your monthly spend down. Health insurance premiums and other medical bills count toward it. If you are married, the allowance you give your spouse at home is taken off first, which can bring your spend down to zero. Only the waiver applicant's own income is counted.

What counts as assets

The asset limit is $2,000 for an unmarried person in a nursing home, and also $2,000 for a married person who needs care (the spouse at home keeps a separate share, below). Some assets are not counted. Ask your Office of Public Assistance which of yours count before you spend down savings.

Gifts and transfers. Medicaid looks back at gifts and sales for less than full value by you or your spouse before you apply. A transfer can cause a penalty period when Medicaid will not pay for long-term care.

What you pay and what you keep in a nursing home

Once you qualify, most of your income goes to the nursing home each month. This is called your cost of care. Before it is figured, these are taken out:

• Personal needs allowance: $50 a month. Veterans can also keep up to $90 a month of VA pension.
• Health insurance premiums, including Medicare premiums.
• An allowance for a spouse at home, and for dependent family members who live with that spouse.
• Some unpaid medical bills from the three months before you applied, not paid by anyone else.
• Home upkeep (single people only): if a doctor says you may go home within six months, you can keep an amount equal to the medically needy level for up to six months to keep up your home.

Life insurance premiums are not deducted. The nursing home gets a notice of what you owe, and so do you.

If your spouse lives at home

• Assets: At application, a resource assessment divides your combined countable assets. Your spouse at home can keep half, but not less than $32,532 or more than $162,660, unless a hearing officer or court sets a higher amount.
• Income: Your spouse can get the lesser of $4,067 minus their own gross income, or $2,705 plus their housing costs above $811.50, minus their own income. The money must actually be given to your spouse.
• Both of you need care? If both spouses are on the waiver, or one is in a nursing home and the other on the waiver, each is treated as a single person.

Home and community care

• Big Sky Waiver: For people who would otherwise need a nursing home. A nurse and social worker team plans your care. Services can include personal assistance, homemaker help, adult day health, respite, home changes, emergency response devices, transportation, private duty nursing, and assisted living (adult residential living). There is a waiting list.
• Community First Choice and Personal Care Services: For Medicaid members who need help with bathing, dressing or medicines at home. Call 406-444-4564.
• Adult foster care: Small family homes for up to four people. Medicaid may help through home and community services.
• PACE: Montana ended its PACE program in 2011.

How to apply

1. Get a referral and screening. For the Big Sky Waiver, call Mountain Pacific at 1-800-219-7035 or 406-443-4020. A pre-admission screening is also needed before nursing home care.
2. Apply for Medicaid online at apply.mt.gov, by phone at the Public Assistance Helpline, 1-888-706-1535 (TTY 711), or at your county Office of Public Assistance.
3. If you are married, ask for a resource assessment so your spouse's share is set.
4. Send papers by mail to DPHHS, P.O. Box 202925, Helena, MT 59620-2925, by fax to 1-877-418-4533, or drop them off at your Office of Public Assistance.

After you apply

• Renewals: You can renew online at apply.mt.gov, by phone at 1-888-706-1535, by mail or fax, or at your Office of Public Assistance. Return your renewal by the date on the letter. If you no longer qualify, DPHHS sends a letter at least 10 days before coverage ends.
• Notices and appeals: You and your spouse both get a notice of the deductions used to figure your cost of care, and either of you can appeal. Follow the appeal steps and deadline on your notice.
• Estate recovery: Montana Medicaid can seek repayment from your estate for care paid after age 55 or while you lived in a nursing home. It does not collect while a spouse, a child under 21, or a blind or disabled child survives. A lien may be placed on real property of nursing home residents who are not expected to go home. Heirs can ask for a hardship waiver.

Things people miss

• High income does not rule you out. Montana's spend down lets people with income above the limits qualify when their care costs are high.
• Join the Big Sky Waiver list early, because there is a wait.
• Ask for the spousal allowance so your spouse at home is not left short.

Free help

• Aging and Disability Resource Centers / Area Agencies on Aging and Montana SHIP: 1-800-551-3191.
• Senior and Long Term Care Division: 406-444-4077.
• Public Assistance Helpline: 1-888-706-1535.

See also paying for a nursing home, Medicare, and all benefits in Montana.

Phone numbers: Free help lines for Montana agencies

Check what you may qualify for