Public Benefits: Medicaid
by: Montana Legal Services Association (MLSA)
What is Medicaid?
Medicaid is a program designed to help low- income Montanans pay for medical bills. Medicaid is divided into full or basic coverage. Medicaid is not an insurance plan.
Medicaid can be confusing. There are many Medicaid programs in Montana. When you are approved for Medicaid, your Office of Public Assistance (OPA) case manager will tell you what kind of coverage you will receive. Also, they will give you a Medicaid handbook which lists many services covered under full or basic.
It is your responsibility to know if you have full or basic benefits.
Where do I apply for Medicaid?
Go to the local Office of Public Assistance to apply for Medicaid. To find your local Office of Public Assistance, call 1-800-332-2272.
To ask questions about Medicaid, call the Medicaid help line at 1-800-362-8312 or visit http://www.mtmedicaid.org.
When will my benefits start?
Generally, your Medicaid benefits will start right after your application is approved.
Your case manager will also inform you when your benefits end.
What are my responsibilities as a Medicaid recipient?
- Report changes in circumstances that may affect your eligibility (income, resources, household member size, etc.) to the OPA within 10 days of the change.
- Provide all necessary information to determine initial and ongoing eligibility.
- Call Nurse First, first. This is an advice line designed to help you determine what kind of care is needed for your symptoms. It is designed to help keep your share of the costs down. The Nurse First Helpline number is 1-800-330-7847.
- Tell your doctor that you have Medicaid and make sure they accept Medicaid.
- Call ahead for an appointment with your doctor and keep your appointments.
- Cooperate with the Third Party Liability (TPL), Child Support Enforcement Division (CSED), Managed Care Division, and Program Compensation.
- Always fill your prescriptions at the same pharmacy.
- Don't sign anything you don't understand. You have the right to use an interpreter, if you need one.
- Pay your cost share. This will be explained once a plan is selected for you. The amount of cost share differs based on the type of services delivered.
- Ask your doctor if Medicaid pays for the bill or if you're responsible for the bill.
Bring your Medicaid card to all appointments.
What are the cost share fees?
Cost share fees can change from year to year. If you have a question about your cost share fees, it would be a good idea to call the Medicaid help line. They should be able to direct you to someone that can tell you what your cost share fees are. Call the Medicaid help line at 1-800-362-8312.
The cost share fees are also outlined in your Medicaid program handbook.
Has this happened to you?
If you are denied Medicaid, you have the right to a fair hearing. See Montana Legal Services Association's pamphlet on "Resolving Disputes About Your Public Benefits."
If Medicaid has denied payment for a service, you have the right to a fair hearing. See Montana Legal Services Association's pamphlet on "Resolving Disputes About Your Public Benefits."
If you feel you have been discriminated against for any reason, use the complaint form provided to you in your Medicaid packet, or contact the Complaint Coordinator at 1-406-444-3131 or TDD 1-800-253-4091.
If a doctor's office is charging both you and Medicaid for the same services, or charging Medicaid for services you did not receive, call the Montana Citizen's Advocate Office at 1-800-332-2272.
I receive TANF. Am I still eligible for Medicaid?
You may be eligible for Medicaid. Receiving TANF does not guarantee that you will be eligible for Medicaid.
If you are a new TANF applicant, you can apply for Medicaid at the same time you apply for TANF.
How long does it take the OPA to make a decision about my eligibility?
A regular application can take up to 45 days. It is important to give the OPA all the information that they ask for.
When you apply for Medicaid, be sure to ask how long your application will take to be processed.
I was eligible for Medicaid before I applied. Will Medicaid pay my paid and unpaid bills?
Yes. Medicaid may pay your bills if they occurred within the three months prior to your application and you were determined eligible in those months. There are certain restrictions to this rule and it is a good idea to ask your caseworker when you apply for Medicaid.
If you did incur medical expenses in the three months before you applied for Medicaid, and you think you were eligible, it would be a good idea to bring your medical bills if you have an application interview. If you do not have an interview, be sure to let your eligibility case manager know that you have these bills.
Revised 02/05
Call the MLSA HelpLine for legal assistance:
(800) 666-6899
Montana Legal Services Association
616 Helena Avenue, Suite 100
Helena, Montana 59601
(406) 442-9830
(800) 666-6124
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