Skip to main content

For your information:

After you apply, end your session to protect your data. Your session will automatically expire after 1 hour and 5 minutes from the beginning of your session, so please log in or submit your application before that time to avoid losing your progress.

Apply for Montana Medicaid Community Engagement Reporting (Form HCS 494) program

Use this form to report your 80 hours per month of qualifying work, education, job training, or community service activities to maintain your Montana Medicaid coverage.
Start an application

How to apply

  1. 1. Select Your Monthly Activities

    Choose the calendar month you are reporting and check the work, school, volunteer, or training activities you completed.

  2. 2. Enter Your Hours & Verification Details

    Enter the hours you completed for each activity and provide organization or Job Service verification details if needed.

  3. 3. Upload Proof & Sign

    Upload copies of supporting documents (such as pay stubs, class schedules, or verification letters) and sign your form online.

To access your application later, create an account

You can check your application status and quickly apply to other programs when you save your information in an account.

Start application with an account

Start application as a guest