Medicaid in Montana provides essential healthcare coverage to eligible low-income residents, including families with children, pregnant women, adults without dependent children, and individuals aged, blind, or disabled. This program covers many services, such as doctor visits, hospital stays, prescription drugs, and preventative care. Eligibility for Medicaid in Montana is primarily based on income, household size, and specific other criteria. The state and federal governments jointly fund the program and aim to ensure vulnerable populations have access to necessary medical services.

Montana Medicaid offers a range of benefits for eligible participants. Here's a summary of the key benefits:

Standard Benefits

1. Dental Care: Includes various dental health services.
2. Doctor, Hospital, and Emergency Services: Access to general and emergency healthcare.
3. Family Planning: Services related to family planning.
4. Home Health Services: Healthcare services provided at home.
5. Laboratory and X-ray Services: Diagnostic services including labs and X-rays.
6. Maternity and Newborn Care: Healthcare during pregnancy and after birth.
7. Mental Health and Substance Abuse Treatment: Services for mental health and substance abuse.
8. Prescription Drugs: Coverage for various medications, subject to certain conditions.
9. Rehabilitative Services and Supplies: Rehabilitation therapies and necessary supplies.
10. School-based Services: Health services provided in school settings.
11. Speech Therapy, Audiology, and Hearing Aids: Services and devices for hearing impairments.
12. Transportation to Appointments: Transportation assistance for healthcare appointments.
13. Vision Care: Eye care services.

Adult Dental Benefits

• Preventative Care: Includes cleaning and fluoride treatments.
• Anesthesia/Sedation Services: Coverage for dental procedures requiring anesthesia or sedation.
• Additional treatments (Restorative, Periodontal, Oral Surgery) are available up to an annual cap of $1,125, excluding certain members like those under 20 or categorically aged, blind, or disabled.

Vision Benefits

• Annual Exam: Every two years.
• Eyeglasses/Eyewear: Provided every two years, subject to prescription changes.

Prescription Drugs

• Coverage Range: Many drugs are covered, but some require prior authorization.
• Supply Limitations: Typically, a 34-day supply is covered, with a 90-day supply for specific conditions.
• Refill Conditions: Early refills possible under specific circumstances (e.g., dosage change), but not for lost/stolen medication or travel.
• Pharmacy Requirements: Drugs are covered only if purchased at a Medicaid-enrolled pharmacy.

The benefit year for Montana Medicaid runs from July 1 through June 30. It's important to note that members must cover costs for services not included in the plan or those exceeding certain limits, such as the $1,125 annual cap for adult dental treatment.

To be eligible for Montana Medicaid health coverage, you must meet specific income criteria based on your family size and age. View the income requirements chart here.

Additional Points

• Residency: You must be a Montana resident.
• Higher Income Eligibility: If your income is above these limits, you may still qualify for financial assistance for health coverage through the Marketplace.
• Tools and Assistance: Use the Healthcare.gov Income Levels and Savings tool to determine potential eligibility.
• Application Process: To apply, visit apply.mt.gov or call the Montana Public Assistance Helpline at 888-706-1535. This platform also allows you to apply for food and cash assistance.It's important to note that the best way to determine your eligibility is by applying, as the application process will consider your specific circumstances and provide the most accurate assessment.

Applying for Montana Medicaid and other reduced-cost health coverage can be done through various methods. Here's a summary of how you can apply:

Ways to Apply for Montana Medicaid

Online

• Apply through the Montana state website by visiting healthcare.mt.gov.
• Alternatively, you can apply via the federal Health Insurance Marketplace at healthcare.gov.

By Phone

• Call 1-800-318-2596 to apply over the phone. This number is for the federal Health Insurance Marketplace, which can process applications for Medicaid.

In Person

• Visit a local community health center or Office of Public Assistance.
• You can find in-person assistance by visiting covermt.org, which will help you locate nearby facilities to apply.

Choosing the most convenient method for you can simplify the application process. Online applications are typically faster, but in-person or phone applications may be preferable if you need assistance or have specific questions.

Montana Medicaid and Healthy Montana Kids (HMK) members must be aware of the redetermination process starting in April 2023.

Renewal Process

1. Redetermination Start: DPHHS will begin redetermining Medicaid/HMK coverage in April 2023 due to the end of the continuous enrollment requirement.
2. Eligibility Check: Your eligibility will be checked sometime in 2023.

Actions to Take

1. Update Contact Information: Ensure DPHHS has your current mail, email, and text message details—update information here.
2. Check Your Mail: Look for letters from the DPHHS Office of Public Assistance about your coverage and if you need to complete a redetermination packet.
3. Complete Redetermination Packet: If you receive a packet, complete it within 30 days. It can be done by calling 1-888-706-1535, online at apply.mt.gov, or by mail. Failing to return the packet by the deadline will result in coverage termination.
4. Report Changes: Inform DPHHS of any household changes affecting eligibility within ten days. This includes changes in address, marital status, household composition, or income.
5. Respond to DPHHS Requests: If contacted for additional information, respond by the due date to maintain coverage.

If You're No Longer Eligible

1. Explore Other Insurance Options: If you're ineligible for Medicaid, you may qualify for health insurance through HealthCare.gov (Health Insurance Marketplace).
2. Seek Assistance from Cover Montana: For help with HealthCare.gov, contact Cover Montana at covermt.org or call 1-844-682-6837.
3. Act Promptly: To avoid gaps in coverage, take action as soon as you know your Medicaid will end.