Montana Medicaid Income Limits (HELP Program, 2026)

Montana Medicaid covers approximately 268,000 residents as of 2024, including about 75,000 adults enrolled through the HELP expansion program. Montana joined the Affordable Care Act's Medicaid expansion in 2016, making it one of the later adopters among Western states. The 2026 Montana Medicaid income thresholds are anchored to the 2026 Federal Poverty Level, published by HHS ASPE: $15,960 for a household of one and $5,680 for each additional household member in the 48 contiguous states. At 138% of those figures, a single adult qualifies for Montana Medicaid with annual income up to $22,025, and a family of four qualifies with income up to $45,540. Montana's MAGI-based Medicaid categories carry no asset test, meaning the state does not count savings, a car, or a home when deciding eligibility for adults, children, and pregnant women.

Montana's HELP Program was first authorized in 2015 by the state legislature under Senate Bill 405 and took effect January 1, 2016. The program has been reauthorized twice: in 2019 under HB 658, and most recently in 2025 under HB 245, which Governor Greg Gianforte signed on March 27, 2025. HB 245 permanently removed the sunset provision that previously required legislative action every few years to continue expansion coverage. Beginning in July 2026, new federal requirements under H.R. 1 will introduce work and community engagement verification requirements for able-bodied adults ages 19 to 64 who are covered through the HELP expansion track. Montana DPHHS administers the program and is working with the federal Centers for Medicare and Medicaid Services (CMS) on implementation. Enrollees should watch for notices from DPHHS about these upcoming changes.

Montana Medicaid covers a broad range of services, including doctor visits, hospital care, preventive care, behavioral health services, prescription drugs, vision, dental (limited for adults), and long-term care. Children enrolled through the Healthy Montana Kids (HMK) or HMK Plus programs receive comprehensive coverage including dental and vision. Montana is a medically needy spend-down state for elderly and disabled residents who need long-term care but have incomes above the standard limit. Those residents spend excess monthly income on qualifying medical costs to become eligible. The 60-month asset-transfer lookback and a home equity cap of $752,000 apply to nursing-home and home-and-community-based services Medicaid in Montana.

Montana Medicaid (HELP Program) income limits by household size (2026)

Montana Medicaid income limits 2026 by household size. Adult and child columns reflect the 138% FPL HELP expansion threshold. Pregnant women column reflects 162% FPL. Children may qualify for Healthy Montana Kids (HMK) CHIP up to 261% FPL (not shown). Based on 2026 HHS Federal Poverty Guidelines for the 48 contiguous states: $15,960 base plus $5,680 per additional person.

Montana Medicaid (HELP Program) eligibility requirements (non-income)

Montana Medicaid eligibility depends on income, residency, age, and citizenship status. The MAGI categories (adults through the HELP expansion, children, and pregnant women) carry no asset test. Elderly, blind, and disabled residents applying for long-term care Medicaid face a separate $2,000 asset limit and a 60-month lookback period for asset transfers.

• Montana residency: The applicant must live in Montana with the intent to remain. Temporary out-of-state stays do not terminate eligibility, but applicants must be Montana residents at the time of application.
• U.S. citizenship or qualifying immigration status: Montana Medicaid covers U.S. citizens, lawful permanent residents (after a 5-year bar for most categories), and certain other qualified immigrants. Emergency Medicaid is available regardless of immigration status for acute care.
• Social Security Number: Every household member applying for coverage must provide a Social Security Number or proof of application for one. Household members not seeking coverage do not need to provide an SSN.
• Age: Adults ages 19 to 64 are covered through the HELP expansion up to 138% FPL. Children birth through age 18 qualify for Montana Medicaid or Healthy Montana Kids (HMK). Adults 65 and older qualify for Medicare first; Medicaid serves as a secondary or long-term-care payor for those who also qualify.
• Income: For MAGI categories, Montana uses Modified Adjusted Gross Income (MAGI). In 2026, the adult HELP expansion limit is 138% FPL ($22,025 annual for a single person; $45,540 for a family of four). Pregnant women qualify up to 162% FPL. Children qualify for Medicaid up to 143% FPL or Healthy Montana Kids (HMK) CHIP up to 261% FPL.
• No asset test for MAGI categories: Montana Medicaid does not count savings accounts, vehicles, retirement accounts, or home equity when determining eligibility for adults, children, or pregnant women in the MAGI-based programs. Only the elderly and disabled applying for long-term care Medicaid face the $2,000 countable asset limit.
• Other health coverage: Having employer-sponsored insurance, Medicare, or other creditable coverage does not automatically disqualify a person from Montana Medicaid, but DPHHS will coordinate benefits. If the other coverage is deemed cost-effective, Montana Medicaid may require the applicant to keep it and pay premiums on their behalf.

What income counts for Montana Medicaid (HELP Program)

Montana Medicaid uses the federal Modified Adjusted Gross Income (MAGI) standard to count income for most applicants. MAGI mirrors how income is reported on a federal tax return, with a few Medicaid-specific adjustments. Montana does not apply a 5% disregard on top of the FPL threshold for adults covered through the HELP expansion; the posted 138% FPL limit is the operative ceiling. The following income types are included or excluded from the Montana Medicaid MAGI calculation.

Income sources included

• Wages, salaries, and tips from employment (W-2 income), including part-time, seasonal, and tipped work.
• Net earnings from self-employment and independent contracting (1099 income after deducting allowable business expenses).
• Social Security Disability Insurance (SSDI) benefits, which are taxable and therefore counted toward MAGI. Note: SSI (Supplemental Security Income) is excluded (see below).
• Unemployment compensation, including state unemployment insurance benefits.
• Interest, dividends, and capital gains from investments and savings accounts.
• Pension income, IRA distributions, and retirement account withdrawals (taxable portion).
• Alimony received under divorce decrees finalized before January 1, 2019 (pre-TCJA agreements only).
• Rental income and royalty income, net of allowable deductions.

Income sources excluded

• Supplemental Security Income (SSI): SSI payments are excluded from MAGI income. However, SSI recipients may qualify for Montana Medicaid under the SSI-linked elderly and disabled categories.
• Child support received: Child support payments received are not counted as income for Medicaid purposes.
• Veterans' benefits: VA disability compensation, pension, GI Bill benefits, and other veterans' payments are excluded from MAGI income.
• Workers' compensation benefits received due to a work-related injury or illness.
• Gifts, inheritances, and one-time lump-sum payments (such as life insurance proceeds) are not counted as MAGI income.
• TANF cash assistance, foster care payments, and most other federal and state public assistance cash payments.

How to apply for Montana Medicaid (HELP Program) in Montana

Montana Medicaid applications are handled by the Montana Department of Public Health and Human Services (DPHHS) through its Offices of Public Assistance (OPA). The state's online application portal at apply.mt.gov accepts applications for Medicaid, Healthy Montana Kids (HMK), SNAP, TANF, and other public assistance programs in a single integrated application. Applicants can also call the Montana Public Assistance Helpline at 1-888-706-1535, visit a local OPA office in person, or apply through a certified community connector such as those listed at covermt.org.

1. 1. Gather your documents: photo ID, Social Security Numbers for all household members seeking coverage, proof of Montana residency, proof of income (recent pay stubs or tax return), and proof of citizenship or immigration status.
2. 2. Start an application at apply.mt.gov. Create a free account or apply as a guest. The application covers Medicaid, HMK, SNAP, and other assistance programs simultaneously.
3. 3. Complete all sections: list every household member, report all income sources, and answer questions about health coverage, residency, and citizenship. Incomplete applications are the leading cause of processing delays.
4. 4. Upload or mail supporting documents. apply.mt.gov allows document uploads directly in the portal. You can also mail documents to your local OPA office or drop them off in person.
5. 5. Submit the application and save your confirmation number. DPHHS will mail a written notice of its eligibility decision. You can also check status online at apply.mt.gov using your account login.
6. 6. Respond promptly to any request for additional information from DPHHS. Failing to respond within the requested window is the second most common reason applications are denied. If approved, your Medicaid card and member ID will arrive by mail within 10 business days.

Official portal: apply.mt.gov

Documents needed

• Photo ID for the head of household (Montana driver's license, state ID, or U.S. passport).
• Social Security Numbers or Social Security cards for all household members applying for coverage.
• Proof of Montana residency: a utility bill, lease or rental agreement, mortgage statement, or mail from a government agency addressed to you at a Montana address.
• Proof of U.S. citizenship or qualifying immigration status: birth certificate, U.S. passport, Certificate of Naturalization, or Permanent Resident Card (green card).
• Proof of income: last 30 days of pay stubs for wage earners; most recent federal tax return with Schedule C for self-employed individuals; benefit letters for Social Security, SSDI, or pension income.
• Health insurance information: if any household member currently has employer-sponsored insurance, Medicare, or other health coverage, include the policy number and insurance card.

Processing timeline: Montana DPHHS typically processes standard Medicaid applications within 30 to 45 days of receiving a complete application with all required documents. Pregnancy applications receive priority and are generally decided within 15 days under federal expedited-processing rules. Applications for elderly and disabled residents requiring a medical or functional needs determination may take up to 90 days. Once approved, coverage is generally retroactive to the first day of the month the application was submitted.

Common reasons applications get denied

• Income above the applicable threshold: the most common reason, especially for adults in two-earner households where combined income exceeds 138% FPL ($45,540 for a family of four in 2026).
• Failure to provide required documentation within the requested timeframe. If DPHHS sends a request for documents and the applicant does not respond, the application is denied without prejudice and can be resubmitted.
• Not a Montana resident: applicants who have recently moved to Montana must demonstrate intent to remain through a lease, utility account, or other evidence of permanent residency.
• Federal 5-year bar for certain lawful permanent residents: most LPRs must wait 5 years after obtaining qualified immigration status before qualifying for full-benefit Medicaid (emergency Medicaid remains available).
• Age category mismatch: adults 65 and older do not qualify for the HELP expansion program; they are directed to Medicare as their primary coverage and may qualify for long-term care Medicaid or a Medicare Savings Program through DPHHS.

If your child's family income is above the Montana Medicaid limit

Montana's Healthy Montana Kids (HMK) program is the state's Children's Health Insurance Program (CHIP). HMK covers children from birth through age 18 in families with household income above the Medicaid threshold (143% FPL) and up to 261% of the Federal Poverty Level. For 2026, a family of four qualifies for HMK with annual income up to approximately $85,931. HMK provides comprehensive coverage including doctor visits, hospital care, prescription drugs, dental, vision, and behavioral health services. Premiums are low or waived based on income. Apply at apply.mt.gov or call 1-888-706-1535. Both Medicaid and HMK are handled through the same application.

Compare Medicaid and CHIP income limits across all 50 states

If you are 65 or older with limited income, Montana Medicare Savings Programs can help

Montana administers three Medicare Savings Programs (MSPs) through DPHHS for low-income residents who have Medicare. These programs pay Medicare premiums, deductibles, and co-pays on behalf of qualifying enrollees. Qualifying Medicare Beneficiary (QMB) covers individuals with monthly income up to approximately $1,350 (2026) and pays Part A and Part B premiums plus deductibles and co-pays. Specified Low-Income Medicare Beneficiary (SLMB) covers individuals with income up to about $1,616 per month and pays the Part B premium only. Qualifying Individual (QI) covers individuals with income up to about $1,816 per month and also pays the Part B premium. Enrolling in any MSP automatically qualifies you for Extra Help (Low Income Subsidy) for Medicare Part D prescription drug costs. Apply through DPHHS at apply.mt.gov or call 1-888-706-1535.

Learn about Medicare eligibility and Medicare Savings Programs

Frequently Asked Questions