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BEFORE THE OFFICE OF FAIR HEARINGS MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES In the Mat

BEFORE THE OFFICE OF FAIR HEARINGS MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES In the Mat 2025

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The document is a Fair Hearing Decision from the Montana Department of Public Health and Human Services regarding Pharmacies, Inc., which contested an alleged overpayment of Medicaid funds totaling $9,854.10. The Department initially claimed a larger overpayment but reduced it after reviewing additional documentation provided by the Provider. The case centered on the adequacy of the documentation submitted by Pharmacies, Inc. to support its claims for Medicaid reimbursement, particularly concerning the use of electronic data versus original paper remittances. The Hearing Officer ultimately ruled in favor of Pharmacies, Inc., reversing the Department's determination of overpayment.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the case number at the top of the form. This is crucial for identifying your specific hearing.
In the 'Identifying Information' section, provide details about Pharmacies, Inc., including any relevant identification numbers and contact information.
Fill out the 'Representation' section with names and titles of individuals representing both parties during the hearing.
In the 'Findings of Fact' section, summarize key points from your documentation that support your case. Use bullet points for clarity.
Review all entries for accuracy and completeness before saving your document. Ensure that all required fields are filled out as per ARM 37.85.414.

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What assets are exempt from Medicaid in Montana?

Understanding Medicaids Asset Limits in Montana Countable assets include cash, investments, and additional properties, while certain assets, such as your primary residence (within equity limits), are exempt. Understanding these rules is key to effective Medicaid planning.

What is the maximum annual income to qualify for Medicaid?

To qualify for free Medi-Cal coverage, your income must align with 138% of the poverty level, based on the number of people who live in your home. The income limits based on household size are: One person: $20,783. Two people: $28,208.

What is the income limit to qualify for Medicaid in Montana?

Montana Medicaid and Healthy Montana Kids (HMK) Plus. Montana Medicaid and HMK Plus are healthcare benefits for eligible low-income Montanans.

How do I verify Medicaid eligibility in Montana?

Check member eligibility by calling Provider Relations at the telephone number below, by calling Integrated Voice Response (IVR) at (800) 714-0060, or accessing the Montana Access to Health (MATH) web portal.

What is the maximum income to qualify for Medicaid in Montana?

Approximate Monthly Income to Qualify for Montana Medicaid, 2025 Family SizeAdults 19-64Children 0-18 1 $1,735 $3,404 2 $2,344 $4,600 3 $2,954 $5,796 4 $3,563 $6,9932 more rows