Written by a parent, not a doctor. Nothing here is medical advice.

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Montana program

Child insurance above the Medicaid line (Healthy Montana Kids)

Montana’s health plan for children above the Medicaid income line (Healthy Montana Kids).

What it is

Montana’s health plan for children above the Medicaid income line (Healthy Montana Kids).

The same application checks Medicaid and Healthy Montana Kids. This option reaches families above the Medicaid line. Existing insurance can block initial eligibility.

Eligibility rules
  • Children must live in Montana and be under 19.
  • From April 1, 2026, monthly limits are $4,707 for two, $5,942 for three, $7,178 for four, $8,413 for five and $9,648 for six, at 261% of poverty.
  • Enrollment in creditable health insurance bars initial eligibility.
  • The office checks actual insurance enrollment and the dates a child could start HMK. It confirms how an unaccepted employer offer, including a public-employee offer, affects your child. Your social worker can help confirm the start date before your family changes an existing plan.
What you get
  • Hospital, clinic, medicine, dental and vision benefits under the plan’s rules.
  • Family copays stop at $215 per benefit year.
What it covers
  • Blue Cross Blue Shield of Montana administers medical benefits.
  • The copay year runs October through September.
  • The October 2025 booklet sets a $215 family copay cap per October–September benefit year. American Indian and Alaska Native members have the booklet’s copay exemption. HMK confirms any separate monthly premium or enrollment fee at 1-888-706-1535; medical benefits questions go to 1-855-258-3489.
If you decide to apply
  1. Your social worker can help you talk with the hospital’s financial counselor about Healthy Montana Kids at apply.mt.gov.
  2. Bring income and insurance details, and ask the counselor to check the oncology team’s network.

1-888-706-1535 — The Office of Public Assistance screens income; Blue Cross Blue Shield of Montana runs the medical network · Official page ↗

After you ask
  • Children receive 12 months of continuous eligibility.
  • HMK does not cover earlier months before the application month. The office confirms the applicable first-of-month start date in writing.
  • The October 2025 HMK medical booklet gives 180 days to appeal, a 45-day standard appeal decision and 90 days to request a hearing after the appeal decision. The notice identifies the process for that decision; HMK Plus uses a different route. Your social worker can help check urgent review and any separate deadline to keep existing services.
Good to know

Other creditable insurance usually blocks a new HMK enrollment. Different rules apply when other insurance starts during an existing 12-month HMK eligibility period; the office checks renewal and coverage dates.

Other details
  • A new plan can change the hospitals, doctors and pharmacies your child can use.

Federal background: CHIP.

Official sources
Ask your social worker

“If Medicaid is unavailable, could Healthy Montana Kids cover our child? How would costs and the network change, and could you help with the application?”

Why I’m asking: I want to understand the next coverage option without creating a treatment gap.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File the one application and say whether the child is enrolled in any other insurance today.

Your social worker

The social worker checks the network for your oncology team before you rely on the coverage.

The care team

Records and letters when the application asks for them.

Who decides
The Office of Public Assistance decides; Blue Cross Blue Shield of Montana administers the medical benefit.
Ask your social worker
“If we are over the Healthy Montana Kids Plus line, will the same application put us into Healthy Montana Kids, and is our oncology team in that network?”

How to apply

First step: Your social worker can help you talk with the hospital’s financial counselor about Healthy Montana Kids at apply.mt.gov.

  1. Your social worker can help you talk with the hospital’s financial counselor about Healthy Montana Kids at apply.mt.gov.
  2. If you decide to pursue this option, your social worker can help review the network, proposed start date and other insurance.
  3. If you decide to pursue this option, your social worker can help review the network, proposed start date and other insurance.

Official application / program page ↗

Where it starts: The same application as Healthy Montana Kids Plus, at apply.mt.gov or by phone.

What to gather

  • This month’s household income
  • Insurance cards for everyone at home
  • Child’s Social Security number and Montana address

How long: The office works to a 45-day standard. Coverage does not backdate.

What a yes looks like

A notice with a start date and a Blue Cross Blue Shield of Montana card. Twelve months of continuous eligibility follows.

What a no looks like, and the next move

If the reason is other insurance, ask exactly which coverage the office counted. If an old three-month waiting rule is mentioned, ask them to check it against current federal rules.

Watch out

  • Your social worker can compare the plans and confirm how actual enrollment or an employer offer affects HMK before any coverage change.
  • The office confirms the proposed first-of-month HMK start date in writing; coverage does not extend to earlier months before the application month.
  • The network is Blue Cross Blue Shield of Montana’s, which is not the Medicaid network.

Dates that change this

2024-06-03: Federal CHIP rules prohibit waiting periods. The June 3, 2024 federal general effective date does not establish Montana’s exact implementation date; the office confirms current eligibility and the start date.

2026-01-01: The eligibility policy says the twelve-month span starts on the first day of the application month, while another paragraph mentions the month after. The span is clear; the actual start date is not, so ask for it in writing. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Children’s coverage to $7,178 a month for four, with family copays capped at $215 a benefit year.

  • $4,707/month — Household of 2, upper line (261% of poverty)
  • $5,942/month — Household of 3, upper line
  • $7,178/month — Household of 4, upper line
  • $8,413/month — Household of 5, upper line
  • $9,648/month — Household of 6, upper line
  • $215/year — Family copayment maximum per October-September benefit year

Covers: Hospital, clinic and specialist care · Chemotherapy and prescriptions · Dental and vision

Legal protection: Twelve months of continuous eligibility · Federal rules prohibit a waiting period, whatever the old state clause says

What it costs the family: The October 2025 booklet caps family copays at $215 per October–September benefit year, with its American Indian and Alaska Native exemption. HMK confirms any separate monthly premium or enrollment fee.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
above the Healthy Montana Kids Plus standard and within 261% of the poverty level
Insurance status condition
enrolment in creditable health insurance bars initial eligibility (ACA 201.5); an offer alone was NOT FOUND either way
Residency
Montana
Continuous eligibility
12 months
Retroactive months
none

The trap: The medical network is Blue Cross Blue Shield of Montana’s, not the Medicaid network. If your oncology team is out of state, check that it is in that network before you count on it.

Where I read this

← Back to your options