Medicaid agency: DPHHS
Montana Medicaid is administered by the Department of Public Health and Human Services (DPHHS), a large multi-program agency; the Medicaid-specific division is the Health Resources Division (HRD). Montana runs a fee-for-service Medicaid program with no comprehensive, risk-based managed care organizations. Primary care case management runs through Primary Care Montana (PCMT), which replaced Passport to Health, Comprehensive Primary Care Plus (CPC+), and the Patient-Centered Medical Home program when all three ended in June 2026; PCMT's first two tiers took effect July 1, 2026, with a third, shared-savings tier targeted for July 2027. Team Care, a separate program locking members to one primary care provider and one pharmacy, continues alongside PCMT. Medicaid expansion under the 2015 HELP Act covers roughly 75,000-80,000 adults and, since House Bill 245, signed March 2025, no longer carries a sunset date, though funding remains subject to biennial legislative reauthorization; federal community engagement requirements took effect July 1, 2026 under the H.R. 1 reconciliation law, with a grace period through October 1, 2026 before enrollees can be penalized for not documenting 80 hours of monthly qualifying activity, and six-month redeterminations beginning January 1, 2027. Two Section 1115 demonstrations run alongside the core program: the Waiver for Additional Services and Populations (WASP), covering low-income adults with severe and disabling mental illness and categorically-eligible aged, blind, or disabled individuals through December 31, 2027, and the Healing and Ending Addiction through Recovery and Treatment (HEART) demonstration, expanding substance use disorder and serious mental illness treatment through June 30, 2027. Children's Health Insurance Program coverage runs through Healthy Montana Kids (HMK), with medical benefits administered through Blue Cross Blue Shield of Montana's provider network; Healthy Montana Kids Plus (HMK+), covering children who qualify through Medicaid rather than CHIP, is delivered fee-for-service directly by DPHHS.
CMS's Medicaid managed care enrollment dataset shows no comprehensive, risk-based managed care organizations operating in Montana. The most recent report year on file, 2024, lists five primary care case management (PCCM) plans, none of them risk-bearing arrangements: Passport to Health, Comprehensive Primary Care Plus (CPC+), the Patient-Centered Medical Home (PCMH) program, Team Care, and a PCCM entity serving tribal reservation areas.
Long-term services and supports run outside managed care entirely, delivered fee-for-service through home- and community-based services waivers: the Big Sky Waiver for individuals 65 and older and those with physical or other disabilities, a waiver for individuals with developmental disabilities, and the Severe and Disabling Mental Illness (SDMI) waiver; the Big Sky and SDMI waivers each operate with concurrent Section 1915(b)(4) selective-contracting authority.
Not integrated into managed care
Behavioral health runs fee-for-service alongside the rest of Montana Medicaid rather than through a separate capitated or administrative-services vendor. The Severe and Disabling Mental Illness (SDMI) waiver covers home- and community-based behavioral health services for adults meeting a nursing-facility level of care, and the Healing and Ending Addiction through Recovery and Treatment (HEART) demonstration, active through June 30, 2027, expands access to substance use disorder and serious mental illness treatment, including short-term stays in institutions for mental disease.
Carved in
No dental benefits administrator is named on DPHHS's Medicaid dental pages; dental runs direct fee-for-service. Healthy Montana Kids (HMK), Montana's CHIP program, likewise routes dental care through Montana Healthcare Programs directly rather than through HMK's own medical-benefits administrator, Blue Cross Blue Shield of Montana.
Conduent has served as Montana Medicaid's pharmacy benefit manager for nearly four decades and renewed its contract for a further three years in July 2024; it also retains legacy fiscal-agent functions (medical authorization, precertification, and inpatient call center services) while the state migrates claims processing to a new vendor.
Mountain-Pacific Quality Health brokers non-emergency medical transportation statewide, preauthorizing trips by personal vehicle, taxi, bus, van, and ambulance and verifying that authorized appointments are kept.
Montana is replacing its Medicaid Management Information System, in continuous use since 1984, in stages: Optum operates the system's Provider Services module, and Gainwell Technologies is building the incoming Claims Processing module (branded the Montana Healthcare Claims System, MTHCS), targeted to go live in 2027 and migrate claims and EDI transactions from Conduent to Gainwell. DPHHS calls this modernization initiative MPATH.
223 agency updates tracked for Montana. Available with Pro.
See them with ProCMS announced $8.7 million in federal funding to purchase new ambulances and medical equipment for rural emergency medical service providers across Montana. The funding is intended to help rural communities replace aging equipment and improve emergency response capacity. Federal officials framed the award as part of a broader push to support rural health infrastructure. Specific implementation timelines and grant recipient details were not detailed in the announcement.
Montana implemented Medicaid work requirements ahead of the national Jan. 1 start date required in most states, requiring beneficiaries to document work, volunteering, or schooling to keep coverage. Beneficiaries and advocates report confusion and anxiety over reporting rules and eligibility verification during the early rollout. The early start makes Montana a preview of implementation problems other states may face when their own work requirements take effect January 1. Enrollees who fail to properly document compliance risk losing coverage, and caseworkers face added administrative burden processing verifications.
Charlie Brereton will step down as director of Montana's Department of Public Health and Human Services on October 30 after four years, moving to the private sector. Dr. Doug Harrington, the department's state medical officer, will replace him. The transition occurs as DPHHS oversees a $233 million federal Rural Health Transformation Program grant, implements new Medicaid and SNAP work requirements set to begin this fall, and manages a $7 billion biennial budget covering Medicaid, behavioral health, and other health and human services programs. Brereton led the agency through Medicaid unwinding, behavioral health investments, and rural hospital stabilization efforts.
States implementing Medicaid work requirements must now determine which disability enrollees qualify for medical exemptions, adding administrative burden to existing eligibility processes. The requirements affect cancer survivors and other disabled beneficiaries who attempt to work but face losing coverage when income or work activity triggers reviews. States must review medical cases for a broader population of Medicaid enrollees to adjudicate exemption requests. The policy creates operational challenges for state eligibility systems already managing disability determinations.
Montana's Medicaid work requirement is causing coverage loss for homeless individuals who cannot meet work or documentation standards due to disabilities like seizures. Adults aged 19-64 must work, volunteer, or participate in job training for 80 hours monthly, or document qualifying exemptions. Homeless individuals face barriers documenting exemptions and accessing exemption-granting providers. The policy affects Montana's expansion population, which includes approximately 100,000 adults.
20 active waivers tracked for Montana. Available with Pro.
See them with Pro1 active solicitations tracked for Montana. Available with Pro.
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