Montana Medical Bill Rights and Protections: HB273 Medical Debt Patient Protection Act, ~$425K Homestead Exemption, and Constitutional Privacy Rights

Article II, Section 10: A Unique Patient Shield

Montana is one of a small number of states with an explicit individual right to privacy written into its constitution. Article II, Section 10 of the Montana Constitution states that the right of individual privacy is essential to the well-being of a free society and shall not be infringed without a showing of a compelling state interest. This has been applied in medical contexts:

• Medical information is protected. Collectors who disclose your conditions, treatment details, or diagnoses to third parties may violate your constitutional rights
• Broader than HIPAA. Applies to non-covered entities including debt collectors and collection agencies
• Defense and counterclaim. Improper disclosure of medical information during debt collection may give you a counterclaim

MCA 30-14-103: A Direct Cause of Action Against Unfair Billing

This broad consumer protection law applies to original creditors like hospitals (not just third-party collectors), giving Montana patients real tools to fight back:

• Applies to hospitals directly. Unlike some states, MCA 30-14-103 covers original creditors (hospitals, physicians, billing companies) in addition to debt collectors
• Up to treble (3x) damages. Courts can award up to three times actual damages, plus a $200 statutory minimum
• Injunctive relief. Courts can order hospitals or collectors to stop unfair practices
• Balance billing. Use this act against surprise balance billing and prices far above posted rates

MCA 71-3-1111 to 71-3-1127: Hospital Liens Only on Personal Injury Claims

Montana's hospital lien statute has important limitations that work in favor of patients:

• Only personal injury claims. Hospital liens in Montana only attach to proceeds from personal injury claims (such as car accident settlements or lawsuits). They do not attach to your home, bank accounts, or other property for general medical debt
• 1-year expiration. Hospital liens expire if not foreclosed within 1 year. If the hospital does not take action within this window, the lien is extinguished
• Must be properly filed. The hospital must follow specific notice and filing requirements for the lien to be valid
• Does not apply to routine medical bills. If you went to the ER for a medical condition (not an injury caused by someone else), hospital liens do not apply

HB273 Prohibits Wage Garnishment for Medical Debt

As of October 1, 2025, HB273 (the Montana Medical Debt Patient Protection Act) prohibits wage garnishment as an extraordinary collection action for medical debt. For non-medical debts, standard rules still apply:

• No wage garnishment for medical debt. HB273 bans this as an extraordinary collection action (effective Oct 1, 2025)
• HSA/medical savings accounts fully exempt. MCA 25-13-603 protects all health savings and medical savings accounts from garnishment
• $3,000 automatic bank account exemption. HB273 protects $3,000 in bank accounts from medical debt collection
• No state income tax. Higher take-home pay and no state tax garnishment
• ~$425,828 homestead exemption (2026). Home equity protected even with a judgment

The HELP Act: Montana's Medicaid Expansion

Montana expanded Medicaid in 2015 through the HELP Act (HB 658), extended in 2019. If you qualify, Medicaid eliminates most out-of-pocket costs:

• • Adults (19-64): Up to 138% FPL (~$20,783/year for a single person in 2026)
• • Premium component: Enrollees between 50% and 138% FPL pay up to 2% of household income
• • Children: Montana Healthy Kids covers children up to 261% FPL
• • No asset test for MAGI-based Medicaid
• • Apply any time at apply.mt.gov or call (888) 706-1535

Montana Hospital Financial Assistance Policies

Montana requires hospitals to post their financial assistance policies. The Montana Hospital Association has also established voluntary commitments for member hospitals. All nonprofit hospitals must offer financial assistance under federal 501(r) rules. Here are key hospital systems in Montana:

What Collectors Cannot Do in Montana:

• Cannot sue after the SOL expires. Medical debt typically has an 8-year SOL (MCA 27-2-202) if intake forms were signed, or 5 years for oral contracts (MCA 27-2-204). After this period, the debt is time-barred.
• Cannot lien your home. Hospital liens only attach to personal injury claim proceeds (MCA 71-3-1111). Home equity is protected by the ~$425,828 homestead exemption (2026). HB273 also explicitly prohibits liens on a primary residence for medical debt.
• Cannot disclose medical info. Montana's constitutional privacy right (Article II, Section 10) protects your medical information from disclosure by collectors.
• Cannot use deceptive tactics. The Consumer Protection Act (MCA 30-14-103) prohibits misrepresenting amounts or threatening actions they cannot legally take. Up to treble (3x) damages.
• Cannot garnish wages for medical debt (after Oct 1, 2025). HB273 prohibits wage garnishment as an extraordinary collection action for medical debt. HSA and medical savings accounts are fully exempt from all garnishment (MCA 25-13-603).

Understanding Rural Montana Healthcare

Montana is the fourth largest state by area with fewer than 1.2 million residents. Rural hospital closures create significant billing challenges:

• Hospital closures. Several rural hospitals have closed, forcing patients to travel long distances for care
• Critical Access Hospitals. Many Montana CAHs operate on thin margins with more limited financial assistance
• Emergency transport. Air and ground transport bills can be substantial for patients transferred to Billings, Missoula, or Great Falls
• Out-of-network risk. Fewer providers means higher out-of-network risk. The federal No Surprises Act covers emergencies

Indian Health Service (IHS) Purchased/Referred Care

Montana is home to seven federally recognized tribes and multiple IHS service units. Patients who are approved for IHS Purchased/Referred Care (PRC, formerly Contract Health Services) have zero liability for the referred services. Key points:

• Zero patient liability. If you are approved for IHS Purchased/Referred Care, the provider must bill IHS directly. You owe nothing for the approved services
• Prior authorization required. PRC referrals must be authorized before services are provided (except in emergencies, where notification within 72 hours is typically required)
• Billing errors. If a hospital bills you directly for PRC-approved services, contact your IHS service unit immediately. You should not be balance-billed for these services

Montana Resources for Medical Bill Help: