Montana pays for home health care and other in-home supports through two waiver programs: the Big Sky Waiver and the Community First/Personal Assistance Services plan. Seniors must be enrolled in Medicaid and have a physician’s care plan to qualify for either of these waivers.

Montana’s Big Sky Waiver

Montana’s Big Sky waiver is open to a limited number of seniors each year who need in-home support to avoid nursing home placement. The program pulls together community resources to deliver home health care and other home supportive services, such as personal care, housekeeping, transportation to medical appointments and some home modifications. Covered services also include physical and occupational therapy, private-duty nursing, mental and emotional health consultations and most specialized medical equipment and supplies. 

Seniors may be eligible for the Big Sky waiver if they meet the income and asset limits of the state’s Medicaid program and have a medical need for care that would normally justify placement in a nursing home. This will be assessed during the intake process, which usually includes a home visit from program workers. Seniors can apply directly to the program through Mountain-Pacific Quality Health, the relevant Area Agency on Aging, rather than through their Medicaid-approved physician or current residential care coordinator.

Community First/Personal Assistance

The Community First/Personal Assistance Services (CFA/PAS) program is Montana’s second in-home support waiver. This plan provides many necessary support services to seniors who are aging in place, including non-medical caregiver assistance, help with light chores and some transportation benefits. Home health services are available through the program, though major expenses like home modifications or deep house cleaning are not. 

CFA/PAS waivers are available in two forms, agency-based and self-directed. Seniors enrolled in the waiver can opt for a managed-care model in which their benefits pay a state-authorized agency to send over home health and in-home caregiver assistance, or they can choose to self-direct their benefits to the caregivers of their choice. Seniors who choose the self-direct option and need home health care must choose a qualified paramedical professional to deliver their medical care at home.

Qualifying for Montana Medicaid

To quality for Montana Medicaid, seniors don’t always need to apply for a waiver to get home health care. Traditional Medicaid is generally able to address the cost for short-term needs or for limited home services and supplies. Single adults who earn less than $13,590 before taxes and have a medical need, such as being a senior aged 65 and older, can get Medicaid with no share of cost. Seniors who earn more than this can still get coverage, though they may have a co-payment.