The Montana Department of Health and Human Services (DPHHS) has extended coverage to postpartum women. This change will now allow postpartum women enrolled in Montana's Medicaid and Healthy Montana Kids Programs to be eligible for 12-month continuous coverage. If you are a member and become pregnant or have any changes to your pregnancy, notify the Office of Public Assistance (OPA). Providing the most updated information on your pregnancy or postpartum status will ensure you are covered under this extension. If OPA is not notified, they will be unable to change or extend your coverage. Women that have become pregnant or had changes to a pregnancy since July 1, 2023, must report these changes to OPA via:
Montana Medicaid and HMK Plus are healthcare benefits for eligible low-income Montanans. Montana Medicaid and HMK Plus pays for services that are:
Passport is the primary care case management (PCCM) program for Montana Medicaid and HMK Plus members. The Passport programs support Medicaid and HMK Plus members, as well as providers, to establish a strong doctor/patient relationship and ensure the appropriate use of services.
In addition to the benefits above, the following treatment services will also be available, subject to an annual cap of $1,125. Members excluded from this annual cap are: age 20 and under and members categorically aged, blind, or disabled. However, service limits may apply. The benefit year runs from July 1 through June 30. You will have to pay for services that are not covered and for those services that go over the $1,125 dental treatment limit for the following list of treatments:
Many prescription drugs are covered. Some prescription drugs may need prior authorization. To find out if a drug you need is covered or to find out if a drug needs prior authorization, talk to your pharmacist or the person who prescribed the drug.
Medicaid will pay for a 34-day supply of drugs. Members may get a 90-day supply of some drugs at the time for heart disease, high blood pressure, or birth control. Early refills may be authorized if the person who writes the prescription changes your dose. Early refills cannot be granted for lost or stolen medication, or for vacation or travel.
Prescription drugs are only covered if you go to a Medicaid-enrolled pharmacy.
When members do not show up for a scheduled appointment, it creates an unused appointment slot that could have been used for another member. It is very important to keep appointments and call the provider in advance if you cannot make it to a scheduled appointment. Medicaid providers cannot bill a member for no-show/missed appointments. However, a provider may discharge a member from their practice after so many no-show/missed appointments. The provider must have the same policy for Medicaid members as non-Medicaid members, and must notify Medicaid members that the policy exists.
For a full list of member rights and responsibilities, see the Member Rights and Responsibilities Section of the Member Guide.
Here is a copy of the Montana Healthcare Programs Member Guide. Be sure to check the announcements section above for information on changes to your benefits.
Need help finding your local Office of Public Assistance, Enrolled Medicaid Provider, or Passport Provider? Call Montana Healthcare Programs, Member Help Line 1-800-362-8312, M-F, 8am-5pm, for assistance.
Find a Montana Medicaid or HMK Plus Dental Provider.
View details about your case.
I lost my Medicaid/HMK Plus Card, call 1-888-706-1535 for a replacement.
Public Assistance Help Line
Eligibility and reporting changes to your case
1-888-706-1535
Medicaid/HMK Plus, Member Help Line
Medical Benefits, copayments, and Passport to Health questions
1-800-362-8312
Medicaid Transportation Services
Contact the Medicaid Transportation Center
1-800-292-7114
