Montana Application for Presumptive Eligibility for Medicaid

State:
Multi-State
Control #:
US-0538BG
Format:
PDF
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Description

Use this form to find out quickly if you qualify for presumptive eligibility for Medicaid. Presumptive eligibility offers you and your family immediate access to health care while you apply for regular Medicaid or other health coverage.
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FAQ

Montana Medicaid and HMK Plus are healthcare benefits for eligible low-income Montanans. Montana Medicaid and HMK Plus pays for services that are: Medically necessary, Provided by a Montana Medicaid/HMK Plus enrolled provider, and.

Who is eligible for Montana Medicaid? Household Size*Maximum Income Level (Per Year)2$19,7203$24,8604$30,0005$35,1404 more rows

The 2021 Montana State Legislature passed a budget that removed funding for 12-month continuous eligibility for most adults on Medicaid and directed DPHHS to end the policy. This change impacts adults covered by Medicaid Expansion as well as adults covered through the Parent/Caretaker Relative category of eligibility.

Under the expanded guidelines, Medicaid is available for all adults with incomes up to 138% of poverty; in 2023, that's $20,120 for a single adult. (Medicaid and CHIP eligibility limits for children and pregnant women are higher, and remained unchanged by the waiver approval.)

A Montana Medicaid prior authorization form is used by a physician to get permission to prescribe a drug that requires prior-authorization from Medicaid. The DPPHS provides Medicaid members with basic healthcare services, but sometimes a patient is prescribed medication that is not covered by Medicaid.

Millions of Americans are at risk of losing their Medicaid coverage in coming months, but residents in Arizona, Arkansas, Idaho, New Hampshire and South Dakota will be the first to bear the brunt of the terminations.

Has Montana expanded Medicaid? Yes, Montana's Medicaid expansion took effect in January 2016, after CMS approved Montana's Medicaid expansion waiver in late 2015. Under the expanded guidelines, Medicaid is available for all adults with incomes up to 138% of poverty; in 2023, that's $20,120 for a single adult.

Medicaid more broadly serves as a safety net for Montanans who are blind and disabled, women who are pregnant or have breast or cervical cancer, families with dependent children, and other adults with low incomes. Medicaid provides coverage for one in four Montanans (265,000 people).

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Montana Application for Presumptive Eligibility for Medicaid