Skilled nursing Medicaid rates in Montana center on a published daily rate of $220.15 for a nursing home stay, effective July 1, 2026 and billed under code G9685. Among the 21 states whose daily rate can be compared directly, Montana ranks 17th, and its rate sits 22.1% below the national median of $282.59.
For a Montana operator, that places the state in the lower third of the comparable group. What sets Montana apart is the cadence of change: the state rewrites its nursing facility payment rule every year, and in both 2025 and 2026 the adopted rule arrived months after the July 1 date it applies to.
A Medicaid nursing facility rate is a per diem: one payment for each resident day, intended to cover nursing care around the clock, room and board, dietary, housekeeping, activities, administration and the building. In Montana that whole bundle is reflected in a single published figure of $220.15.
The rate is paid through Montana Medicaid and HMK Plus on a fee-for-service basis, the state's main program for direct payment to providers. Because the rate is set by rule rather than negotiated plan by plan, a facility's revenue per Medicaid day is predictable. The trade-off is that a daily rate 22.1% under the national median leaves less room to absorb cost pressure than in most comparable states.
Across 44 states with a published rate, 21 publish a figure that can be ranked directly, with a median of $282.59.
| State | Daily rate |
|---|---|
| New Mexico | $826.00 |
| Colorado | $419.22 |
| National median | $282.59 |
| Montana | $220.15 |
| Connecticut | $107.21 |
| Arkansas | $70.00 |
New Mexico's $826.00 is the national maximum, and the next tier of high-paying states sits between $365.78 and $419.22. Montana is well below that tier. Connecticut, Michigan and Arkansas report lower figures, so Montana is not at the floor of the ranking, but it is closer to the bottom than to the middle.
For a facility whose census is weighted toward long-stay Medicaid residents, the per diem largely determines whether operations break even. Medicare-covered short stays and private-pay days carry more of the margin in a state with a rate at this level.
Rural scale
Many Montana facilities are small and serve large rural areas. Small buildings have less room to spread fixed costs such as administration, dietary and plant operations across residents, so a below-median per diem bites harder. A facility that is the only nursing home in its county also carries a community role that is hard to price but easy to lose if margins stay negative.
Occupancy
Fixed staffing means each empty bed spreads cost across fewer paying residents. In a small building, two or three empty beds can be a meaningful share of the census. Census management is as important as rate management.
Montana rewrites its nursing facility payment rule through the Administrative Rules of Montana, mainly ARM 37.40.307, with ARM 37.40.315 also amended in 2025.
The 2025 cycle
- MAR Notice No. 2025-93.1 (proposal), published November 7, 2025, proposed amending both rules on Medicaid nursing facility rates, with a 3.0% change effective July 1, 2025.
- MAR Notice No. 2025-93.2 (supplemental) reached the hearing stage on December 19, 2025.
- MAR Notice No. 2025-93.3 (adoption) was published March 20, 2026, still effective July 1, 2025.
The 2026 cycle
- Nursing Facility SPA, posted for public comment June 30, 2026, with a July 1, 2026 effective date.
- MAR Notice No. 2026-113.1 (proposal), published July 24, 2026, amending ARM 37.40.307.
- MAR Notice No. 2026-113.2 (adoption), published September 25, 2026, effective July 1, 2026.
An earlier set of Multiple State Plan Amendments, posted April 12, 2024, carried a 7.01% change effective July 1, 2024.
Both recent cycles share a pattern: the rule takes effect July 1, but the final adoption is published months later. In 2025 the adoption came in March of the following year; in 2026 it came in late September.
The practical consequences are concrete. Between July 1 and the adoption, facilities are paid at a rate that may later be revised. When the adoption arrives, claims for the gap period are reconciled to the adopted rate. Facilities reconciling July through September 2026 should check that payments reflect the adopted rule rather than the prior year's rate.
For budgeting, the proposal notice is the best early signal. The 2025 proposal named a 3.0% change, which gave facilities a working figure months before adoption. Watch for the next proposal notice in the months after July 1, 2027, and plan cash flow around the possibility of a retroactive adjustment. The Montana state page lists each notice with a link to its source document.
A per diem has to pay for three levels of nursing staff. Montana's wage data from May 2025 shows a labor market that is slightly cheaper than the national median at every level.
- Registered nurses: $41.00 an hour in Montana, against a national median of $46.90.
- Licensed practical nurses: $29.91 in Montana, against $30.96 nationally.
- Nursing assistants (CNAs): $19.67 in Montana, against $20.32 nationally.
The gap is widest for registered nurses and narrow for nursing assistants, who make up the largest share of direct-care hours in most facilities. That matters for reading the rate: Montana's daily rate is 22.1% under the national median, but its CNA wage is only modestly lower than the national figure. A facility's largest labor cost therefore does not fall nearly as far as its Medicaid revenue per day.
Operators competing for nurses with hospitals and home health agencies in the same market also face wage pressure that a statewide median does not capture. In remote areas, recruiting may require housing support or travel staff, both of which raise cost above the median.
Our data shows no prior authorization rules attached to code G9685 in Montana and no published unit limit. For nursing facility care, the gate to Medicaid payment is usually the level-of-care determination and financial eligibility rather than a per-claim authorization, and nothing in the published Montana rate data adds a separate authorization step on the daily rate.
That simplifies billing: once a resident is eligible and the facility is enrolled, the per diem is paid for each covered day at the published rate. The work shifts to the front door, making sure eligibility and level-of-care paperwork is complete before the stay begins, since a gap there delays every day of payment that follows.
Because Montana pays the facility day under a single code at a single published rate, billing errors tend to come from the edges of the stay rather than from the rate itself.
Admission and discharge days
Facilities should apply the state's rules on which days count as covered, especially the day of admission and the day of discharge or death. A consistent internal rule, checked against remittances, prevents small per-claim differences from adding up across a year.
Leave and hospital days
Residents who leave temporarily for a hospital stay or home visit raise questions about whether the bed is paid while they are away. These rules vary by state and change with rulemaking, so the current ARM text, not habit, should decide how such days are billed.
Rate changes mid-claim
When a retroactive adoption changes the rate, claims spanning July 1 may need adjustment. Keeping July claims separate from June claims makes that reconciliation simpler.
Montana Medicaid pays nursing facilities on a fee-for-service basis. Our data does not classify any Montana service line as paid through risk-based managed care, so there is no plan-specific rate to negotiate for a nursing home day. We record 17 plans and care-management arrangements in Montana, including Primary Care Montana tiers, Team Care and the Tribal Health Improvement Program, which coordinate primary care rather than set facility rates.
For nursing home operators, the published per diem is the rate that applies. The Montana managed care page summarizes how each arrangement works.
Montana's Big Sky Waiver serves elderly and physically disabled adults at home, and Community First Choice and Personal Care Services fund in-home support. These are the main alternatives to a nursing home stay. As they grow, the residents who enter facilities tend to need more care, which raises cost per day while the per diem is fixed for the year.
See Montana home care rates and Montana private duty nursing rates for how those alternatives are priced.
- Budget on a July 1 year with a reconciliation line. Adopted rules can arrive months later and apply retroactively.
- Read the proposal notices. They name the expected change before adoption.
- Track cost per resident day against $220.15. Labor first, then fixed costs per bed.
- Front-load eligibility work. With no per-claim authorization, payment depends on complete eligibility files.
- Compare with higher-paying states carefully. Rhode Island and Colorado pay far more, but their labor markets differ.
Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. Rule changes come from MAR notices in the Montana Administrative Register and state plan amendment postings. Montana's nursing facility line holds 114 current rates, part of all 141,671 current Montana Medicaid rates, with history back to 2007.
The skilled nursing industry hub compares daily rates across all states, our methodology explains how rates are ranked, and pricing covers access to the full Montana dataset.