What is the Healthy Montana Kids Plan (HMK)?

HMK provides free or low-cost health care coverage to Montana children, from birth until the month of their 19th birthday. There are two coverage groups: HMK, which used to be known as the Children's Health Insurance Plan (CHIP) and HMK Plus, or Children's Medicaid.

Who is eligible for HMK?

Coverage through HMK is available to children wh

• Meet the plan's eligibility guidelines
• Reside in the home at least 50% of the time
• Are U.S. citizens or qualified aliens
• Are Montana residents
• Are under the age of 19
• Have been uninsured for three months or more (exceptions apply - call 1-877-543-7669 for details)
• Are not residing in an institution for mental disease or a correctional institution at the time of the application for HMK
• Have parents who are not employed by the State of Montana or the Montana University System

What are the HMK income guidelines?

To be eligible for HMK, a family's income must meet certain guidelines. The table below shows income requirements according to family size:

Healthy Montana Kids Income Guidelines*

* Guidelines effective October 1, 2009

Families who earn more than the guidelines should still apply because additional income adjustments are made based on the number of family members who are employed and whether they pay for child care or care for a disabled or dependent adult.

There is also a summary of the income guidelines located here.

Do I need to provide proof of income to apply for HMK?

Yes. Applicants must submit proof of all earned and unearned income for household members. Examples include copies of pay stubs, Unemployment Insurance documentation, self-employment income/expense statements, award letters for Social Security or disability payments, etc.

HMK does not consider a family's assets or resources when determining a child's eligibility.

What else do I need to apply for HMK?

The application asks for each child's date of birth and Social Security number. In some cases, applicants must submit other proof of citizenship or immigration status (usually a certified copy of a birth certificate) for the children. If a child has insurance at the time of application, the application asks for information like policy number, name and address of insurance company.

For children 16 and older, applicants must submit a copy of a photo ID, like driver license or school, state or tribal ID. And anyone in the home age 18 or older must sign and the date the application.

What are Enrollment Partners?

Enrollment Partners (click the link for a list) are Montanans who have been trained to help families apply for HMK. Enrollment Partners do everything from sharing resources (like copiers or fax machines, for example) to helping with specific application questions to helping with citizenship and identity verification.

How do I get an application for HMK?

Applicants can complete and submit an online application at www.hmk.mt.gov. Applicants can also download the application for printing.

Applications are also available at Offices of Public Assistance, county health departments, health care facilities, WIC offices, Head Start facilities, Indian Health Services, and Enrollment Partner locations.

HMK will also mail applications. Call 1-877-KIDS-NOW (1-877-543-7669) to request an application.

Where do I send my completed HMK application?

Mail the completed application to:

HMK
Dept. of Public Health and Human Services
P.O. Box 202951
Helena, MT 59620-2951

Or, fax the completed application to 1-877-418-4533 (toll-free fax) or 1-406-444-4533 in Helena.

How long will it take to determine my child's HMK eligibility?

The Department of Public Health and Human Services has 45 working days to determine a child's eligibility.

How long is my child covered?

Children are eligible for 12 months. Families must renew coverage annually.

Which health care providers accept HMK?

HMK is accepted by providers across Montana.

Which services does HMK cover?

Children may get the following services:

• Office and clinic visits
• Emergency and hospital services
• Prescription drugs
• Dental services
• Vision exams and eyeglasses
• Sports or employment physicals
• Anesthesia
• Surgical services
• Well-child checkups
• Laboratory and X-ray services
• Mental health and substance abuse services
• Hearing exams/hearing aids, and more

HMK also covers pre-existing conditions.

What about deductibles and other payments?

No family pays more than $215 per year in co-payments.

Where do I report changes that affect my HMK eligibility?

Call 1-877-543-7669 to report any changes that might affect your eligibility, including changes in family size or a new mailing address.

What should I do if I have complaints about HMK?

If the complaint is regarding HMK enrollment or eligibility, send written complaints to:

HMK Supervisor
Dept. of Public Health and Human Services
PO Box 202951
Helena, MT 59620

Or you can e-mail the complaint to HMK@mt.gov. If the complaint is about medical benefits paid through HMK, you must contact Blue Cross Blue Shield of Montana at 1-800-447-7828 ext. 8647.

If you are not satisfied with the complaint resolution, you may pursue a fair hearing.

How do I pursue a fair hearing?

You must request a fair hearing in writing to the HMK office (at the address above) within 90 days of the Department's action notice.

The Department may want to have an administrative review with you. This is advisable to do because most problems are resolved at the administrative review. Note that you are not required to go to an administrative review.

If you have any questions regarding a fair hearing, please feel free to contact Montana Legal Services Association's hotline at (800) 666-6899.

You should also see Montana Legal Services Association's pamphlet on "Resolving Disputes About Your Public Benefits."

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