- What is Medicaid?
- Who can get Medicaid?
- What is Healthy Montana Kids Plus?
- How does Medicaid work?
- What services are covered on Medicaid?
- Do I have to be a U.S. Citizen to get Medicaid?
- Does it matter how long I have lived in Montana?
- What are resources? What resources are counted for Medicaid?
- Are there any resource limits for Medicaid?
- How is Medicaid different for pregnant women?
- What is the Medically Needy Program
- Do I have to cooperate with the child support office to get Medicaid?
- How do I get an application?
- What is the application like?
- Do I have to go in person to apply?
- What do I have to do to stay on the program?
- How often do I need to renew coverage for Medicaid?
- What is a co-pay?
- Are there co-payments (co-pays)?
|2. Who can get Medicaid?|
Children ages 18 and under are eligible for Healthy Montana Kids Plus (HMK Plus). Families with dependent children, pregnant women, women diagnosed with breast or cervical cancer or pre-cancer, the aged (65 or older), and people who are blind or disabled (based on Social Security criteria) can all get Medicaid. (But adults who do not have children living in their household cannot get Medicaid unless they are aged, blind or disabled.) You have to live in Montana. You also have to be a U.S. Citizen or a qualified alien to get Medicaid. Most people also have to have income and assets below the limits to get Medicaid.
NOTE: The rest of this document is written for children (up to age 18), parents (or caretaker relatives [adults who are related within the fifth degree of kinship such as a grandparent]), with children under age 19 living with them, and pregnant women who want to get help from Medicaid. It does not talk about how Medicaid works for other people, such as those who are aged, blind or disabled.
|3. What is Healthy Montana Kids Plus?|
Prior to October 1, 2009 Healthy Montana Kids Plus (HMK Plus) was called children's Medicaid. HMK
Plus is health coverage for
low-income children in Montana and is also run by DPHHS.
Children can receive HMK Plus two ways:
Benefits for HMK Plus are Full Medicaid benefits. In addition, children covered by HMK Plus receive all medically necessary services. These can be more than the established Full Medicaid benefits.
- By filling out a Healthy Montana Kids application (click here to apply online) just for the children (HMK will determine if the child should get HMK or HMK Plus benefits)
- or by applying for Family Medicaid, kids will get HMK Plus if the family is eligible, or if the adults are not eligible the kids will be considered for HMK Plus (which have more generous income standards)
|4. How does Medicaid work?|
Montana Medicaid has two types of coverage; basic and full coverage.
- Full Medicaid means that you are eligible for all services that are medically necessary. Individuals who are aged, blind, disabled, or pregnant receive full Medicaid coverage. Children, 18 or younger can get Healthy Montana Kids Plus, and receive full Medicaid benefits.
- Basic Medicaid means that some services are not paid for by Medicaid, except in the case of an emergency or where a job requires the services. Generally, people receiving basic benefits are adults over age 20.
Medicaid looks at every family member individually to see who can get help. Some people in your family may be able to get Medicaid, but others may not. Individuals who are accepted for Medicaid or HMK Plus, will receive a Montana Access to Health card (children will receive a Healthy Montana Kids Plus Card) with name, member number, and date of birth on it in the mail. You will need to bring this card with you whenever you go to the doctor, pharmacy, or get any health service. You will also have to sign up for Passport to Health, a managed care plan for Montanans with Medicaid. Passport helps people get good health care because each person has a Passport provider that manages his or her health care. You will choose a primary care provider (PCP)--this can be a doctor, nurse practitioner, physician assistant, or medical clinic--to be your Passport provider. You will see your PCP for most services and get your PCP's okay before seeing another provider or going to the hospital for non-emergency services. If you do not have Passport you can get health care from any provider who is a Medicaid or HMK Plus provider. Be sure to ask if the provider is a Medicaid or HMK Plus provider before you make an appointment.
|5. What services are covered on Medicaid?|
Medicaid or HMK Plus pays for most health care services, but not everything. All Medicaid and HMK Plus services must be medically necessary. Medicaid services include; doctor and clinic visits, family planning, immunizations, prenatal care and delivery, inpatient (hospital) and outpatient surgery, most prescription drugs, eye exams and eyeglasses (with some limits), dental work and exams (exams are only for full coverage Medicaid recipients or children covered under HMK Plus), podiatry (foot) services, chiropractic care (for children covered under HMK Plus or individuals with QMB co-insurance), medical equipment and supplies, rehabilitative therapies (PT, OT and speech), lab and x-ray services, alcohol and drug treatment (residential and outpatient), and mental health service. HMK Plus covers child and teen check ups. Dental care for adults is limited based on the type of coverage (basic versus full). Basic Medicaid covers dental services if the service is essential for employment or in emergency situations. You can look at a more comprehensive list of services provided by clicking here. Some services must be pre-authorized.
|6. Do I have to be a U.S. Citizen to get Medicaid?|
No. Qualified aliens can also get Medicaid. Proof of alien status and identity must be provided to be eligible for Montana Medicaid. Any alien who is 'otherwise eligible' can be covered under emergency alien coverage if they have an emergency situation - pregnant women are the most common, and coverage only applies to the delivery as that is what is considered an emergency, but medicaid can cover others (such as children or aged individuals).
- A new federal law requires most MA applicants and enrollees to prove that they are U.S. citizens and give proof of their identity when they apply for or renew their coverage. This includes U.S. nationals from American Samoa and Swains Island.
- Types of proof of identity include, Driver's license, State ID card, military dependent ID card, Tribal ID or documents, Federal or local government ID Card, Military card or draft record, school ID with picture, and Nursery or day care records.
- You do not have to show proof if you are getting Medicare benefits or if you receive Supplemental Security Income (SSI).
|7. Does it matter how long I have lived in Montana? |
No. But you must be a Montana resident and plan to stay in Montana to get Medicaid.
|8. What are resources? What resources are counted for Medicaid?|
Resources are monies or other things of value that you or your family own. Medicaid will evaluate all resources to determine which resources are countable and which are excluded in the resource determination. You do not have to count the home you live in and may exclude one vehicle with the highest equity value and all income-producing vehicles as resources. The equity values of any other vehicles are counted. Personal items such as clothes, furniture, jewelry and appliances are not counted. Some examples of resources that are counted are cash, money in a checking or savings account at a bank, recreational vehicles like 4-wheelers, property that you do not live on, and stocks and bonds, trusts and annuities.
Note: Certain Montana Medicaid programs do not have resource limits (Family-Extended, Family-Transitional, Pregnancy-Extended, and Breast and Cervical Cancer Treatment, HMK Plus).
|9. Are there any resource limits for Medicaid?|
Depending on the type of Medicaid you are eligible for, resource limits
are $3,000 for families, for aged, blind or disabled households, the
limits are $2,000 for an individual and $3,000 for a couple. There are
no resource limits for the HMK Plus program. The new Montana Medicaid for Workers with Disabilities program has an increased resource limit; $8,000 for an individual, and $12,000 for a couple. For more info on the Montana Workers with Disabilities Program, click here.
|10. How is Medicaid different for pregnant women?|
There is a Medicaid Program to cover pregnant women, there are income and resource limits. A pregnant woman may qualify to receive care for up to 60 days post birth.
|11. What is the Medically Needy Program|
This program provides Medicaid to certain groups of individuals who are not otherwise eligible for Medicaid. Persons who spend down by incurring medical expenses so that, after medical expenses, their income falls below a state-established medically needy income limit (MNIL). A persons spend down must be met each and every month that they want Medicaid coverage. The opportunity to spend down is particularly important to elderly individuals residing in nursing facilities and children and adults with disabilities who live in the community and incur high prescription drug, medical equipment, or other health care expenses.
|12. Do I have to cooperate with the child support office to get Medicaid?|
For some programs, yes. If you do not cooperate, you will not be able to get Medicaid. But your children can get Medicaid even if you do not cooperate with the child support office. However, if you have a good reason for not wanting to cooperate (for example, if you fear physical or emotional harm to you or your child), you may not have to cooperate. Also, a pregnant woman, who is not medically needy, does not need to cooperate in order to get coverage. If this applies to you, you have to tell your worker that you want to claim “good cause.” You will have to fill out a form to explain your situation.
|13. How do I get an application?|
You can get an application at your county Office of Public Assistance (OPA). You can access your local OPA number and address by calling the Montana Citizens' Advocate office at 1-800-332-2272. You may also get applications by clicking here and visiting this website.
If you are not applying for family medicaid, but only for children, you can apply for HMK Plus by simply filling out the HMK application, click here for a link to that 8 page application. Mail the application and required documents into the Healthy Montana Kids office in Helena at:
Healthy Montana Kids PlanOr fax the application toll free to: 1-877-418-4533 and mail the required original documents. You may also apply for HMK online at the HMK website.
PO Box 202951
Helena, MT 59620-2951
|14. What is the application like?|
The application is 17 pages long, including directions. It is available in English and Spanish. The application will ask you about everyone who lives with you, how much money they make and what they own (resources). You will also have to provide proof of your income (such as pay stubs or tax returns) and assets. You can fill it out yourself or you can get help filling it out from a county worker or other groups. You can use the Quick Program Lookup on this website to find places that help in your county.
|15. Do I have to go in person to apply?|
No. You can apply for Medicaid by sending your application and documents of proof in the mail to your county Office of Public Assistance and have your Medicaid interview conducted by telephone. You can also take them to your county Office of Public Assistance to turn them in.
|16. What do I have to do to stay on the program? |
Changes need to be reported within 10 days of knowledge of the change - so if you know today that you are starting a job on Dec 1st, you need to report the change within 10 days from today, not 10 days from Dec 1st. Things you must report include births, deaths, moving, obtaining or losing insurance coverage, income or job changes, and people moving in or out of your household. You also have to renew your coverage by mail. This means telling your worker updated information about you and your family to make sure that you can still get Medicaid.
HMK Plus has 12 months of continuous eligibility. Changes need to be reported, but kids receiving HMK Plus do not lose eligibility regardless of changes in family income.
|17. How often do I need to renew coverage for Medicaid?|
Every twelve months, you will have to renew your coverage. You will get a “Redetermination Form” in the mail that asks you questions. Fill it out and mail it back right away so that you can keep getting your Medicaid. If you move, be sure to let a Medicaid worker know your new address so that you will get this letter.
|18. What is a co-pay?|
It is a small amount of the total bill that you have to pay when you get some services (get a prescription, get eyeglasses, etc.).
|19. Are there co-payments (co-pays)?|
Some people have to pay a copay to the provider when they receive medical care if they are:
- 21 years old or older
- not living in a nursing home
- not pregnant
Copay amount vary from:
- $1 to $5 for each prescription, but not to total more than $25 added together in one month
- $1 to $9 for each visit to a provider
- $100 for each overnight hospital stay
Some Medicaid services do not have a copay requirement. There is no copay for HMK Plus services.