Medicaid FAQ Sheets

Table of Contents 

• What Is Medicaid?
• What Healthcare Does Medicaid Cover?
• How Much Does Medicaid Cost?
• How to Qualify for Medicaid in Montana
• How to Apply for Medicaid in Montana
• How to Make Changes to Your Application
• How to Check Your Application Status
• What Happens After You Apply for Medicaid?
• How to Appeal a Denial of Benefits
• What Happens to My Medicaid If I Move?
• Need More Help?
• View or Download Our Free Guide

What Is Medicaid?

Medicaid is a federal U.S. health insurance program that provides health coverage to millions of Americans. The program primarily covers low-income adults, children, pregnant women, elderly adults and people with disabilities.

Federal guidelines for the Medicaid program are established by the Centers for Medicare and Medicaid Services (CMS). Learn more about Medicaid at a national level on the CMS website here.

The Montana Medicaid program is administered by the Montana Department of Public Health and Human Services. Learn more about Medicaid in Montana on the Department of Public Health and Human Services website here.

What Healthcare Does Medicaid Cover?

Through Medicaid, people gain access to health care services that may not be affordable without it. Additionally, some programs and benefits include special protections—such as provider networks and payment methods—that help ensure services are accessible. Medicaid also provides preventive care and other services to help people stay healthy and avoid costlier care.

Medicaid covers medical and health care services such as:

• Doctors visits
• Vision and dental care
• Family planning services
• Home healthcare
• Hospital care
• Laboratory and x-ray services
• Maternity services
• Mental healthcare
• Nursing home services
• Prescription drugs
• Transplants
• Transportation services

Medicaid does not cover the following types of medical services:

• Cosmetic procedures or surgeries
• Certain dental services like braces and gold caps
• Unnecessary hospital expenses, like TV rentals or meals for guests
• Any services not covered under the State Plan for Medical Assistance

Learn more about medical and health care services that are covered by Medicaid in Montana at the Department of Public Health and Human Services here.

How Much Does Medicaid Cost?

Medicaid recipients in Montana may need to pay a monthly premium, which is a monthly fee for enrollment in the program. Premium amounts are based on the recipient’s annual income and will total two percent of your yearly income billed monthly.

Recipients may sometimes need to pay a small out-of-pocket cost for treatments, which are known as copayments. Copayment amounts depend on the recipient’s age, household income and what the state pays for the specific service.

Each Medicaid participant through the Montana Department of Public Health and Human Services has their own individual health care plan. Some participants may be required to pay fees, and some recipients may not be required to pay fees, i.e., are exempt.

To learn more about Medicaid premiums, click here. To learn more about Medicaid copayments, click here.

How to Qualify for Medicaid in Montana

To qualify for Medicaid in Montana, you must meet all of the following:

• Be a resident of Montana
• Be a U.S. citizen or have a qualifying immigration status
• Meet the Medicaid program’s income limits

Income limits vary depending on household size, medical status and other factors and are subject to change annually.

Find further information on Montana Medicaid eligibility here.

How to Apply for Medicaid in Montana

To apply for Medicaid in Montana, complete the following two steps:

1. Choose how you are going to apply, whether online, by mail, in person, or by fax.

To apply for Medicaid online, click here to access the online Montana Medicaid application.

To apply for Medicaid by mail, email hhssspapplcationcustomersupport@mt.gov to request the application form, fill it out and mail it to your local Office of Public Assistance

To apply for Medicaid in person, click here to find your nearest Office of Public Assistance.

To apply for Medicaid by fax, request an application form, fill it out, and fax it to (877) 418-4533. 

2. Submit your application.

If you have questions about the application process or require assistance, call the Montana Public Assistance Helpline at (888) 706-1535.

Or, contact your nearest local Montana Office of Public Assistance. Find contact information for local field offices in Montana here or refer to the list below.

How to Make Changes to Your Medicaid Application

Montana Medicaid recipients must report changes that can influence their eligibility status. You can report a change: Find forms for reporting different changes below:

• Online through ePass Montana, here.
• By phone at (888) 706-1535 
• In person at a local Montana Office of Public Assistance. Find contact information for local Medicaid field offices in Montana here.

How to Check Your Application Status

You can check the status of your Medicaid application by calling the Montana Public Assistance Helpline at (888) 706-1535.

What Happens After You Apply for Medicaid?

The Montana Department of Public Health and Human Services (DPHHS) will review your application to verify if you are eligible for Medicaid. In some cases, the state may ask for additional information before approving your application. Montana will mail applicants a letter detailing if their Medicaid application was approved or denied.

How to Appeal an Application Denial

Medicaid applications will be denied if applicants do not meet the eligibility requirements. Also, beneficiaries can have their benefits terminated or reduced if their eligibility status changes while they are enrolled.

If your Medicaid application is denied or the amount of your benefits is reduced, you have the right to file an appeal. You must send a written appeal request by the date shown on your determination letter. Your letter will also include instructions for filing your appeal with the DPHHS.

The Montana Department of Public Health and Human Services will review your claim and may ask for additional information or evidence of your eligibility. If you are granted a hearing, you will receive a notice with the date, time and location of the hearing.

Learn more about hearings here.

What Happens to My Medicaid If I Move?

Montana Medicaid recipients must report changes that can influence their eligibility status, including relocating to a new address.

If you move to a new residence within Montana, you can update your address by notifying the Montana Department of Public Health and Human Services in the following ways:

• Online through ePass Montana, here.
• By phone at (888) 706-1535 
• In person at a local Montana Office of Public Assistance. Find contact information for local Medicaid field offices in Montana here.

Note: Medicaid benefits do not transfer. If you move to a new state, you must reapply for Medicaid in your new location. If you have further questions about moving with Medicaid, visit the national Medicaid Contact Us here.

Need More Help?

For help with a Medicaid application, or for any further questions about the Medicaid program, contact the Montana Department of Public Health and Human Services.

• By phone at (888) 706-1535 
• By fax at (877) 418-4533 
• By mail at:

Human and Community Services
P.O. Box 202925
Helena, MT 59620

You can also visit or call a local Office of Public Assistance for further assistance. Find your nearest field office location and contact information here.

View or Download Our Free Guide

While we are not affiliated with the government in any way, our private company engaged writers to research the Medicaid program and compiled a guide and these answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.

Our free Medicaid Guide is filled with helpful information about how to apply, program eligibility and how to get in touch with local offices. You can view or download our free guide here.

Last Updated: September 21, 2022