Montana program
Getting treatment in another state approved
Montana Medicaid reviews planned hospital care and transplants outside the state before treatment.
What it is
Montana Medicaid reviews planned hospital care and transplants outside the state before treatment.
An out-of-state referral adds insurance steps. The team requests admission approval. Travel help follows a separate process.
Eligibility rules
- Your child must have Montana Medicaid.
- Mountain Pacific reviews out-of-state inpatient requests.
- Transplants require prior approval and medical necessity.
What you get
- Coverage for approved out-of-state inpatient care.
- Medically necessary transplants approved in advance.
What it covers
- The team explains why the needed care cannot be given in Montana.
If you decide to apply
- Ask the social worker who sends the request and how to get its reference number.
- Bring the Medicaid number, hospital and planned dates.
Mountain Pacific, for the state · Official page ↗
After you ask
- The team can provide the reference and written decision.
- Travel approval comes from the transportation center separately.
- For a planned out-of-state admission, the treatment team needs to arrange the required approval and confirm that the receiving hospital is enrolled to bill Montana Medicaid for the dates of care. Emergency transfer is different and should not wait for advance paperwork; the team should obtain the post-admission instructions directly including the applicable deadline. Provider Relations at 1-800-624-3958 can check enrollment, and Mountain Pacific at 1-800-219-7035 handles the inpatient review route. Transport and lodging approvals are separate.
Good to know
A referral does not prove planned admission approval. Emergency transfer should not wait for advance paperwork.
Other details
- Passport referral numbers are no longer required for dates of service after June 30, 2026. A later claim-submission date does not remove a referral requirement for an earlier service; medical orders and prior-approval rules still apply.
Official sources
“If our child needs treatment elsewhere, what needs approval and what might we owe? Could you help coordinate hospital and travel arrangements if we go ahead?”
Why I’m asking: I want to understand coverage before an out-of-state trip.
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 reference number and check the receiving hospital takes Montana Medicaid.
Your social worker
The team sends the authorisation request and the clinical justification.
The care team
Writes why the care cannot be given in Montana.
- Who decides
- Mountain Pacific, for the state.
- Ask your social worker
- “Before we travel out of state, has the Montana Medicaid out-of-state authorisation been sent? Can I have the reference number, and does that hospital take Montana Medicaid?”
How to apply
First step: Ask the social worker whether the out-of-state authorisation has been sent, and for the reference number.
- Ask who is sending the out-of-state authorisation, and when.
- Ask for the reference number and keep it.
- Check the receiving hospital takes Montana Medicaid before you travel.
Official application / program page ↗
Where it starts: The treating team requests it; you should ask for the reference number.
What to gather
- The receiving hospital’s name and the planned dates
- The Medicaid number
- The reference number once it exists
How long: For non-drug Medicaid authorization requests in 2026, standard review generally takes seven calendar days, with a permitted extension of up to 14 days; urgent review generally takes 72 hours. These clocks do not delay emergency care. Mountain Pacific confirms post-admission notice requirements.
What a yes looks like
An authorisation reference for the admission, before you travel.
What a no looks like, and the next move
A refusal on medical necessity or because the care is available in Montana. Ask for the reason in writing and use the appeal date.
Watch out
- Ask who sent the authorisation and when; do not assume the hospital did it.
- The team needs to confirm the receiving hospital’s Montana Medicaid enrollment for the service dates. A general statement that it accepts Medicaid is not enough.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Out-of-state inpatient care and transplants are covered when authorised in advance by the state’s review organisation.
Covers: Authorisation of out-of-state inpatient admissions · Transplant approval on medical necessity
What it costs the family: None when it is authorised first.
The eligibility facts, as published
- Coverage
- Montana Medicaid
- Authorisation
- Mountain Pacific does prior authorisations for out-of-state inpatient admissions through its portal
- Transplant
- prior approved and medically necessary
The trap: Do not rely on the hospital to have done it. Ask who sent the out-of-state authorisation, when, and what the reference number is.
Where I read this
- Hospital transfers: in state versus out of state — Montana DPHHS, read September 10, 2026
- Hospital Inpatient Services Manual — Montana DPHHS, read September 10, 2026
- Referrals, medical orders and prior authorization from July 1, 2026 — Montana DPHHS, read September 10, 2026
- Seattle Children's insurance plans we accept — Seattle Children's Hospital, read September 10, 2026