Montana currently has two HCBS 1915(c) waivers that serve children and waive parent income. See Montana’s Long Term Care page for more information on Montana’s programs. Montana also has a Community First Choice program that allows anyone enrolled in Medicaid to receive personal care services.

Montana Advocacy Organizations:

Last updated 3/18/25

Programs in Montana

Also called Comprehensive Waiver

  • Target Population: Children and adults with developmental or intellectual disabilities.
  • Ages: all
  • Levels of Care: Intermediate Care Facility
  • Income Waiver: Yes, the waiver is based on the child’s income only. Parent income is not counted.
  • Waiver Type: 1915(c)
  • Spots: 2880
  • Expiration Date: 6/30/2028
  • Description from medicaid.gov: Provides day supports and activities, homemaker, residential habilitation, respite, nutritionist services, occupational therapy, physical therapy, private duty nursing, speech therapy, supports brokerage, adult foster support, assisted living, behavioral support services, caregiver training and support, community transition services, companion services, environmental modifications, individual goods and services, meals, personal care, personal emergency response system, personal supports, psychological evaluation/counseling and consultation services, remote monitoring equipment, remote monitoring, retirement services, specialized medical equipment and supplies, supported employment (co-worker support), supported employment (follow along support), supported employment (individual employment support), supported employment (small group employment support), and transportation services to individuals with intellectual disabilities or developmental disabilities ages 0 or older who meet an ICF/IID level of care.
  • Online State Information: Developmental Disability page
  • Official Federal Information
  • How to Apply: Contact the nearest DDP Regional Office.
  • Waiting List: Montana has 1749 people with developmental disabilities on its waiting list.
  • Target Population: Children and adults with physical or other health disabilities.
  • Ages: all
  • Levels of Care: Nursing Facility
  • Income Waiver: Yes, the waiver is based on the child’s income only. Parent income is not counted.
  • Waiver Type: 1915(c)
  • Spots: 2783
  • Expiration Date: 06/30/2029
  • Description from medicaid.gov: Provides adult day health, big sky waiver personal assistance, case management, community adult group homes, day habilitation, homemaker, prevocational services, respite, supported employment, audiology, respiratory therapy, speech therapy, financial management services – self direction, independence advisor – self direction, adult foster care, community transition, consultative clinical and therapeutic services, dietetic-nutritionist services, environmental accessibility adaptations, family training and support, health and wellness, homemaker chore, level 1 assisted living, level 2 assisted living behavioral health modification, level 3 assisted living specialized care, member directed goods and services, money management, non-medical transportation, nurse supervision for personal care attendants, nutrition, occupational therapy, pain and symptom management, personal emergency response systems, physical therapy, post acute rehabilitation services, senior companion, service animals, skilled nursing, specialized child care for children who are medically fragile, specialized medical equipment and supplies, specially trained attendant, and vehicle modifications services to individuals ages 65 or older and individuals with physical disabilities or other disabilities ages 0-64 years who meet a nursing facility level of care.  This waiver operates with a concurrent 1915(b)(4) authority.
  • Online State Information: Big Sky Page
  • Official Federal Information
  • How to Apply: Contact the Mountain Pacific Quality Health Foundation at 1-800-219-7035.
  • Waiting List: Montana has 1749 people with developmental disabilities and 380 people with physical/health disabilities on its waiting list.

Additional Information

  • According to its 2023 Waiver Application, the DD Waiver allows parents/guardians of minors to be paid for care. “A legally responsible individual is a biological or adoptive parent of a recipient under 18, or a spouse of an adult recipient. The services legally responsible individuals may provide include: Residential Habilitation, Supported Employment-Follow Along Support, Companion Services, Personal Care, Personal Supports, Supported Employment-Co-Worker Support, Supported Employment-Individual Employment Support, and Supported Employment- Small Group Employment Support. For a legally responsible person to be paid for the provision of any of the aforementioned services all of the following authorization criteria and monitoring provisions must be met. The service(s) must: 1) Meet the definition of a service/support as outlined in the federally approved waiver plan; 2) Be necessary to avoid institutionalization; 3) Be a service/support that is specified in the member service and support plan; 4) Be provided by a parent or spouse who meets the provider qualifications and training standards specified in the waiver for that service; 5) Be paid at a rate that does not exceed what is allowed by the department for the payment of similar services; and 6) Not be an activity that the family would ordinarily perform or is responsible to perform. Extraordinary care means care exceeding the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the participant and avoid institutionalization.”
  • In the Waiver Application for Big Sky, parents/guardians may be paid for personal care. “The state makes payment to legally responsible individuals for the provision of extraordinary care when the care is in the best interest of the member. A legally responsible individual includes biological and adoptive parents of recipients under 18, spouses of adult recipients, and court appointed guardians. Extraordinary care is defined as care exceeding the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the participant and avoid institutionalization. Care can include line of sight supervision, night supervision or when not required by a person without a disability of the same age. Authorization of services are based on recommendations of the plan of care professional, as well as comparison to the developmental stage of an equivalent person without a disability of the same age. The following services may be provided by a legally responsible person: Personal Assistance Services (BSW/PAS), Specially Trained Attendant, Homemaker, Homemaker Chore.”
  • Montana now has a Pediatric Complex Care Assistant Program. View the legislation here. Parents/guardians are able to be paid to provide tube feedings, trach care, medications, and personal care services. More information is available here.