Nursing Homes in Montana
Aging is rarely easy, both for those experiencing it and the family members responsible for arranging care. When families plan how to manage the health issues that come with old age, they must consider what's best for their loved one's health, dignity and level of independence. A family might not have the time, resources or medical knowledge to take care of a parent at home. For example, seniors living at home may be at higher risk of accidents and health emergencies.
Nursing homes are a solution for those whose needs require more round-the-clock attention, offering seniors health care and supportive services in a secure, homelike environment. Nearly one-fifth of Montana's residents are 65 or older, and more than 3,000 Montanans live in one of the state's 71 certified nursing facilities. While care in a nursing home can be expensive, there are programs to assist eligible seniors and those with significant needs.
This guide explains the process of securing nursing home care for yourself or a loved one with medical assistance programs. Read on to learn about eligibility, the application process and the services that are provided.
Popular Cities in Montana
Cost of Montana Nursing Homes
The average cost of nursing homes in Montana is $210 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Montana?
Those who cannot afford nursing home care in Montana can use Medicaid to help cover the monthly costs. The Montana Department of Public Health and Human Services (DPHHS) administers the MT Medicaid program. It supports seniors in nursing care facilities, assisted living, adult day cares and at home through additional services. Montana's long-term aging programs fall into three categories: Medicaid for nursing homes (entitlement program), home and community-based services (non-entitlement waivers) and regular Medicaid services (entitlement programs where services are not provided through a nursing home).
As of December 2022, with coverage expanded to low-income adults, 322,482 Montanans have enrolled in Medicaid and CHIP. Individuals in nursing homes receive 24/7 emergency monitoring and health care checks. Those not eligible for this form of Medicaid coverage may receive waivers or additional services to cover at-home care for seniors. Montana waivers cover at-home costs for aging family members, including meals, occupational and speech therapies, medication administration and medical supplies.
Eligibility for Medicaid in Montana
For Medicaid to cover long-term care in a Montana nursing home, seniors must demonstrate a medical and financial need. To be eligible for nursing home Medicaid, an individual must receive income less than the cost of a nursing home and have less than $2,000 in assets. The financial eligibility requirements differ for Medicaid waivers and regular Medicaid and depend on whether one or both spouses are filing.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | Less than nursing home costs | $2,000 |
| Two-Person Household (Both Spouses Applying) | Less than nursing home costs | $4,000 ($2,000 per spouse) |
| Two-Person Household (One Spouse Applying) | Less than nursing home costs | $2,000 (applicant); $148,620 (nonapplicant) |
*Per month
Nonfinancial eligibility requirements include citizenship and residency status, medical need group and immigration status. Medicaid applicants need to demonstrate:
- Residency in Montana
- U.S. citizenship or other permanent legal status
- Medical need
Applying for Medicaid in Montana
People who want to apply for Montana Medicaid can do so online, in person or over the phone. Online applicants can visit healthcare.gov and select Montana as their state. Alternatively, applicants can reach the Montana Department of Health and Human Services (MDHHS) office by phone at 1-800-318-2596 to speak to a representative. For in-person applications, covermt.org provides a list of local health centers and public assistance offices throughout the state. They can guide applicants through the process.
What Information You Will Need:
- Name, address, contact info and birth date for each household member
- Social Security numbers and/or immigration documents (only for those applying)
- Household income statements (including pay stubs or W-2 forms)
- Social Security Administration (SSA) or Supplemental Security Income (SSI) payments
- Current health coverage information for household members (insurance through an employer, spouse's employer or Medicare)
Additional Medicaid Support & Resources in Montana
Free resources are available to help Montana residents and families better understand the Montana Medicaid program and how to qualify. People can get free assistance with the application process online, over the phone or in person.
| Contact | Service | |
|---|---|---|
| Montana Public Assistance Helpline | (888) 706-1535 | Montana DPHHS staff attend a hotline to answer any questions about public health benefits in Montana. In addition to providing guidance with Medicaid, the Office of Public Assistance fields questions about food programs, unemployment and other state benefits. |
| Cover Montana | (844) 682-6837 | Cover Montana helps Montana residents who aren't sure if they qualify for Medicaid or who need advice on how to apply. The program offers a live chat function through its website and manages a hotline. Additionally, it provides a calculator for family members to determine if they might qualify. |
| Centers for Medicare & Medicaid Services | (800) 332-6148 | CMS offers resources so consumers can better understand various state benefits, from Medicaid and Medicare to Montana's State Health Insurance Assistance Program (SHIP). The website includes phone numbers for additional resources, and a hotline is available. |
Can You Use Medicare to Pay for Nursing Home Care in Montana?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Montana
While Medicare may not cover assistance with activities of daily living (ADLs) or indefinite nursing home stays, it provides coverage for over 250,000 Montana residents to help lower their insurance costs. The following public health agencies and Area Agencies on Aging (AAAs) help seniors make more informed choices when choosing a Medicare plan to suit their lifestyle and health care needs.
| Contact | Service | |
|---|---|---|
| Montana Area Agencies on Aging | (800) 551-3191 | Ten AAAs are spread across Montana, each providing seniors with county-specific resources and support services. These agencies also work alongside local senior centers, where Montana residents can receive personalized assistance with choosing a Medicare or Medicare Advantage plan. |
| Montana State Health Insurance Assistance Program (SHIP) | (800) 551-3191 | The State Health Insurance Assistance Program is the official state aggregate connecting Medicare beneficiaries, family members and providers to trained health care counselors. Counselors can give answers in a range of Medicare question areas, from eligibility to the enrollment process. |
| Montana Aging and Disability Resource Centers (ARDC) | (800) 551-3191 | Montana Aging and Disability Resource Centers (ARDC) train counselors to assist seniors with the Medicare enrollment process, clarifying the differences between Medicare and Medicare Advantage and recommending additional resources as required. |
| Montana Department of Public Health and Human Services – Senior and Long-Term Care Division | (888) 515-6565 | With a mission to, "advocate and promote dignity and independence for older Montanans and Montanans with disabilities," the MDPHHS's Senior and Long-Term Care Division provides information and assistance with planning long-term senior health care services. |
Other Financial Assistance Options for Nursing Home Care in Montana
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and apply online at va.gov. | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Montana
| Licensing Requirements | Long-term skilled nursing and intermediate care facilities are licensed by the Department of Public Health and Human Services, Office of Inspector General. |
| Staffing Requirements | Nursing facilities are required to retain a minimum number of RNs, LPNs and CNAs in proportion to the number of licensed beds in the facility and depending on the shift. Each staff member must have up-to-date licenses issued by the state authority. |
| Staff Training Requirements | Registered nurses and nursing assistants must complete 75 hours of training with 16 hours of clinical practice to comply with both state and federal Medicare requirements prior to employment. Staff members must undergo periodic training updates depending on job capacity and resident needs. |
| Admission Restrictions | Skilled nursing facilities must maintain written policies and procedures for admitting new residents, and a licensed practitioner must perform an evaluation to determine whether a potential resident exhibits sufficient medical need. Should the medical examiner deny admission, prospective residents may appeal. |
| Care Planning Requirements | Skilled nursing facilities are required to maintain an individualized care service plan for each resident, including treatment goals, medications, care services and provider details. Depending on the admission category, licensed nurses are required to review the plan bimonthly or in case of a sudden change. |
| Dietary and Nutritional Services Requirements | Nursing homes are required to employ a dietician to monitor adherence to nationally recognized nutritional standards when planning resident meals. Facility kitchen staff must serve three meals per day, offering sufficient nutritional value while accommodating each resident's dietary restrictions or preferences. |
| Specialized Rehabilitative Services | As long as it is directed by a licensed physician, nursing homes may provide rehabilitative care. Provided they hold the proper licenses, staff members may conduct the training themselves. Otherwise, outside therapists may be contracted to perform services on-site. |
| Medication and Pharmaceutical Services | Montana nursing homes must administer all prescribed and emergency medications to their residents in accordance with individual care plans and standard emergency procedures. Licensed pharmacists are required to review each resident's prescription four times per year at minimum. |
| Activities Requirements | Montana nursing homes are required to provide or coordinate activities. Each facility must contain at least one central area for socialization and recreational purposes. |
| Infection Control Requirements | As they provide health care services in close proximity to vulnerable populations, skilled nursing facilities must follow clearly outlined policies and procedures in regard to health and safety. These policies outline employee health screening, hand-washing procedures, the use of face masks and hazardous waste disposal. |
| Medicaid Coverage | Montana Medicaid offers long-term care benefits for seniors needing the services of a nursing home and who devote the entirety of their income to pay for these services (minus a personal needs allowance). |
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