Montana Medicaid Home and Community Based Services Waiver (Big Sky Waiver)


State Policies & Initiatives: 
Medicaid & Employment

“This Montana Medicaid program allows individuals that require nursing home level care to receive that care in their home or community in place of in a nursing home.  A wide variety care services and non-care support is provided both to the program participant and to their primary caregiver to allow them to live at home or in an assisted living residence.  Even minor home modifications which can decrease the beneficiary's reliance on other persons are considered an allowable expense.


This waiver is also referred to as the Elderly/Physically Disabled Waiver and Big Sky Home and Community Based Services.


Under this waiver, Montana residents have the option of self-direction or consumer direction. Meaning, participants have the right to choose their care providers. However, care providers are subjected to approval by the state. Interestingly, certain family members are eligible to be hired as personal care attendants. Typically, spouses are excluded from this option but under certain circumstances spouses can be paid providers.  More commonly, the adult children who are caring for aging parents are paid as caregivers. Care providers must be qualified to provide care therefore the types of care family members can be paid to provide is usually limited to personal care or homemaker services.”

  • Medicaid Agencies
  • Home and Community Based Services (HCBS)
Date Enacted: