Montana uses a nursing-home income and cost-of-care process
For 2026, Montana’s categorically needy institutional standard is $30 per month and its medically needy income level is $525 per month. DPHHS states that otherwise eligible institutionalized individuals and spouses are income eligible when monthly nursing-home cost equals or exceeds monthly income; the resident’s payment responsibility is then calculated under the Step II process (DPHHS ABD 008 2026 standards; DPHHS ABD 013 nursing-home income policy).
In Step II, DPHHS says the institutionalized individual’s gross monthly income, less allowable deductions, is applied to cost of care when Medicaid contributes. The rule distinguishes this post-eligibility calculation from the different medically needy spend-down calculation used when Medicaid is not contributing (DPHHS ABD 805-2 PETI policy).
The published personal-needs allowance is $50
The DPHHS PETI policy lists a $50 personal-needs allowance, or the remaining income if less than $50, among the allowable deductions from a Medicaid-funded institutional-care budget. It also says veterans receive an additional exclusion of up to $90 per month in VA pension income and that VA pension income over $90 per month is countable (DPHHS ABD 805-2 PETI policy).
The DPHHS consumer nursing-home brochure separately says that most residents may keep $50 per month from their checks for personal needs and that residents receiving only SSI may keep $30. Because that consumer brochure identifies itself as current as of February 2025, the live DPHHS policy or facility budget should be checked for the application month (DPHHS nursing-home Medicaid brochure; DPHHS PETI policy).
Other listed deductions can include up to $65 of earned income, a qualifying community-spouse income allowance, family maintenance allowance, eligible medical or remedial expenses, and stated court-ordered support payments. The details matter because deductions cannot exceed the resident’s gross income (DPHHS ABD 805-2 PETI policy).
Married residents have separate protections
Montana publishes a separate resource assessment for married institutional or waiver applicants. Its 2026 allowance for the community spouse is generally one-half of countable couple resources between $32,532 and $162,660, subject to the published hearings-officer and court-order provisions (DPHHS CMA 001 2026 standards; DPHHS CMA 803-1).
Families should not assume that facility admission, financial eligibility, the level-of-care screen, and patient liability occur on the same date. DPHHS specifically says Medicaid payment is unavailable before the screening date, provided the other criteria are met (DPHHS nursing-home Medicaid brochure).
Montana nursing-facility basics: a Screening Determination/Level-of-Care review, financial eligibility, and a Step II cost-of-care budget. The published personal-needs allowance is $50 per month, or remaining income if lower (
DPHHS CMA 802-1;
DPHHS PETI policy).
Not mutually exclusive. Most families combine two or three funding pillars — this one rarely stands alone.
The
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