Healthy Montana Kids — Health Coverage When a Grandparent Is the Caregiver

Your Income Does Not Count

When a non-parent relative — a grandparent, aunt, uncle, or adult sibling — applies for children's health coverage through DPHHS, the state evaluates eligibility using Modified Adjusted Gross Income (MAGI). The grandparent's income is excluded from the child's health unit unless the grandparent has legally adopted the child. For most kinship placements, the child's own income is close to zero, which puts them well within eligibility thresholds.

This works the same way whether you have a formal court order, a caretaker relative affidavit, or an entirely informal arrangement. What matters is that the child lives with you and you are applying on their behalf.

Two Coverage Tiers

Montana runs two programs through DPHHS for children's health coverage:

Children's Medicaid (HMK Plus) covers children whose family unit income falls at or below approximately 143% of the Federal Poverty Level. This provides comprehensive EPSDT coverage — well-child exams, immunizations, dental, vision, behavioral health, prescription medications — with zero copayments or premiums.

Healthy Montana Kids (HMK) covers children whose income exceeds the Medicaid threshold but stays at or below 261% FPL. HMK delivers medical, dental, and vision care with minimal cost-sharing.

Since the child's individual income is what gets tested, most children living with relative caregivers qualify for zero-cost Medicaid.

What EPSDT Covers

Children enrolled in Montana Medicaid receive Early and Periodic Screening, Diagnostic, and Treatment benefits. That includes:

• Routine well-child exams and immunizations
• Complete dental coverage (cleanings, fillings, and orthodontia when medically necessary)
• Vision exams and prescription eyeglasses
• Behavioral health care and outpatient therapy
• Prescription medications at zero copay

This is comprehensive coverage. If a child needs something medically necessary, EPSDT requires the state to provide it.

How to Apply

DPHHS accepts health coverage applications through:

• Online: apply.mt.gov or covermt.org
• Phone: Montana Public Assistance Helpline at 1-888-706-1535, or Cover Montana at 1-844-682-6837

Standard processing takes up to 45 days (90 days if a disability determination is required). You do not need a court custody order to apply. A grandparent providing daily care can apply on the child's behalf.

Renewals and Continuous Eligibility

Montana provides 12-month continuous eligibility for enrolled children, so minor income fluctuations during the year will not cause coverage to drop. At the 12-month mark, DPHHS attempts automatic renewal using state databases. If they need documentation from you, a renewal packet is mailed with a 30-day response window.

If coverage is terminated because you missed the renewal paperwork, it can be restored without a brand new application if you submit the missing documents within 90 days of closure.

If the Child Needs Care Before the Card Arrives

If a child requires immediate medical attention or prescription refills while an application is still processing, contact the Public Assistance Helpline (1-888-706-1535) or Cover Montana (1-844-682-6837) to ask about options for pending applicants.

Getting Organized

Health coverage is one piece of the financial picture. Grandparents and relatives in Montana often qualify for TANF child-only cash grants, SNAP, childcare scholarships, and other programs at the same time. The Financial Help for Grandparents and Relatives Raising a Child in Montana guide covers every program, how to apply for all of them together, and how to track renewal deadlines so coverage does not lapse.

See more Montana guides →