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

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Montana program

Spend-down Medicaid for a month of huge bills

A monthly Medicaid route that subtracts allowed medical bills from income (medically needy spend-down).

What it is

A monthly Medicaid route that subtracts allowed medical bills from income (medically needy spend-down).

A costly treatment month can change the Medicaid calculation. Montana subtracts allowed bills and compares what remains with a low standard. Household resources are also tested.

Eligibility rules
  • Family Medically Needy uses a $3,000 filing-unit resource ceiling. Disability-based Medicaid has different resource rules, including $2,000 for an individual. The office determines the category and which resources count.
  • Coverage starts once the medical bills you owe bring your income down to the medically needy level: $658 a month for three people, $792 for four. Those figures have not changed since 2001, so nearly all of a month's income has to be spent on bills first.
What you get
  • Medicaid for a qualifying month after the spend-down is met.
What it covers
  • Paid or unpaid bills from the benefit month and previous three months can count.
  • Current payments on older bills may also count.
  • With the cash option, an approved spend-down payment can establish coverage for the whole eligible month; the expense option starts coverage when enough allowable bills have met the spend-down. Bills used to meet it remain your responsibility and are not paid again by Medicaid. Your social worker can help the office compare both options and identify the exact covered dates and bills.
If you decide to apply
  1. Your social worker can help you talk with the Office of Public Assistance about a month-specific spend-down calculation.
  2. Bring the month’s bills, bills from the previous three months, older-bill payments and account balances.

1-888-706-1535 — The Office of Public Assistance · Official page ↗

After you ask
  • The office calculates the spend-down for the month requested.
  • A cash option can be reviewed with the office.
Good to know

The income standard is what remains after allowed bills. Each month is assessed separately.

Other details
  • Hospital itemized charges help the office identify allowed expenses.

Federal background: Medically needy Medicaid.

Official sources
Ask your social worker

“Could our bills open Medicaid for a costly month? What would we still owe under spend-down or the cash option, and could you help us compare and apply?”

Why I’m asking: I want to know whether a month of large bills changes our coverage options.

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

Ask for the assessment by name and hand over the bills for that month and the three before it.

Your social worker

The hospital billing office itemises the month’s charges so they can be counted.

The care team

Records and letters when the application asks for them.

Who decides
The Office of Public Assistance, month by month.
Ask the agency
“We had a very large hospital month. Can you do a medically needy assessment for that month, and tell me what the cash option would cost?”

How to apply

First step: Your social worker can help you talk with the Office of Public Assistance about a month-specific spend-down calculation.

  1. Your social worker can help you talk with the Office of Public Assistance about a month-specific spend-down calculation.
  2. If you decide to pursue this option, your social worker can help review allowed expenses, resources, covered dates and remaining bills.
  3. If you decide to pursue this option, your social worker can help review allowed expenses, resources, covered dates and remaining bills.

Official application / program page ↗

Where it starts: Apply the usual way and ask for a medically needy assessment, or the cash option, for the month with the bills.

What to gather

  • Every bill from the benefit month and the three months before it
  • Receipts for payments on older bills
  • This month’s income

How long: No practical timeline is published. Ask the office to date-stamp the request.

What a yes looks like

Medicaid for that month, and a figure to pay in if you took the cash option.

What a no looks like, and the next move

Usually the bills did not reach the standard, or resources were over $3,000. Ask which, and ask again next heavy month.

Watch out

  • The standard is what is left after bills, not your pay: $792 a month for four.
  • Family Medically Needy uses a $3,000 filing-unit resource ceiling. Disability-based Medicaid uses separate category rules, including $2,000 for an individual.
  • It is decided one month at a time, so ask again for each heavy month.

The numbers and the rules

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

What it is worth

Medicaid for a month once bills bring countable income to $525 for two, $658 for three, $792 for four, $925 for five or $1,058 for six.

  • $525/month — Household of 2, monthly medically needy standard
  • $658/month — Household of 3, monthly medically needy standard
  • $792/month — Household of 4, monthly medically needy standard
  • $925/month — Household of 5, monthly medically needy standard
  • $1,058/month — Household of 6, monthly medically needy standard
  • $3,000 — Family Medically Needy filing-unit resource ceiling

Covers: Full Montana Medicaid for the covered month

Legal protection: Bills from the benefit month and the three months before it can be counted

What it costs the family: Bills used to meet the spend-down remain your responsibility. The office compares those costs with the approved cash-option payment.

The eligibility facts, as published

Income
countable net income after allowable medical expenses at or under the monthly standard (CMA 002)
Resources
Family Medically Needy uses a $3,000 filing-unit resource ceiling. Disability-based Medicaid uses separate category rules, including $2,000 for an individual.
Budget period
one month at a time (CMA 002, January 1, 2026)
Expenses
paid or unpaid bills from the benefit month or the previous three months, plus current payments on older bills

The trap: The monthly standards include $792 for four and $658 for three, effective July 1, 2001 and restated January 2026. They apply after allowable expenses, not to gross earnings. Family Medically Needy uses a $3,000 filing-unit resource ceiling. Disability-based Medicaid uses separate category rules, including $2,000 for an individual.

Where I read this

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