How to Pay for In-Home Care
How to Pay for Home Care in Montana
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
Montana families typically start by screening Community First Choice Services/Personal Care Services (CFCS/PCS) for hands-on home care, then look at the Big Sky Waiver when a nursing-facility level of care plus waiver services are needed (note that Big Sky currently carries a waiting list). CFCS/PCS offers self-direction, but spouses and parents of minor children are excluded from reimbursement under the linked PCA policy, though Big Sky and the 0208 waiver have narrower routes for qualified legally responsible relatives under specific rules; a Medicaid-enrolled child under 21 with complex medical needs may also qualify for the Pediatric Complex Care Assistant program, which can let a trained, licensed parent or relative provide physician-ordered complex care. Adults with intellectual/developmental disabilities should look at the 0208 Comprehensive Waiver, those with severe disabling mental illness at the SDMI HCBS Waiver, and anyone transitioning out of an institution at Money Follows the Person, with AAA/ADRC services, TCARE, respite, Big Sky Rx, Medicare Savings, SNAP, energy assistance, property-tax relief, and Veteran benefits layered on as cost offsets.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
Montana Medicaid / Big Sky Waiver
Big Sky Waiver (BSW)
YesHelps pay for: Medicaid HCBS that can substitute for nursing-facility care through home- and community-based services.
Who qualifies: Medicaid financial eligibility, nursing-facility level of care and an unmet need that requires BSW services; the program currently has a waiting list.
How to start: Request a BSW referral and level-of-care screening through Mountain Pacific.
Good to know: Family caregiver payment: Sometimes - specified qualified relatives may be paid
BSW Personal Assistance
YesHelps pay for: Hands-on help with ADLs can replace privately purchased home-care hours.
Who qualifies: BSW enrollment and care-plan authorization; worker/provider qualifications apply.
How to start: Ask the BSW case manager to assess personal-assistance needs and delivery options.
Good to know: Family caregiver payment: Yes in limited cases under BSW legally responsible relative rules
BSW Homemaker
Yes - homemakerHelps pay for: Homemaker assistance can reduce private-pay spending for routine household tasks tied to remaining safely at home.
Who qualifies: BSW enrollment; service must be needed and authorized in the plan of care.
How to start: Request homemaker services during BSW service planning.
Good to know: Family caregiver payment: Yes in limited cases under waiver rules
BSW Respite
Yes - respiteHelps pay for: Temporary relief for an unpaid caregiver can reduce privately purchased relief care.
Who qualifies: BSW enrollment and assessed caregiver/respite need.
How to start: Ask the case manager to include respite in the plan of care.
Good to know: Family caregiver payment: No direct wage to the primary unpaid caregiver
BSW Adult Day Health
Indirect / day careHelps pay for: Daytime supervision, health and support services can reduce paid or unpaid home-care hours.
Who qualifies: BSW enrollment, assessed need and provider availability.
How to start: Ask whether adult day health fits the service plan.
Good to know: Family caregiver payment: No
BSW Environmental Adaptations
Indirect cost offsetHelps pay for: Home modifications can reduce safety risk and the amount of hands-on assistance needed.
Who qualifies: BSW enrollment; modification must address an assessed functional/safety need and be authorized.
How to start: Request an environmental-adaptation assessment through the case manager.
Good to know: Family caregiver payment: No
BSW Personal Emergency Response System (PERS)
Indirect cost offsetHelps pay for: Emergency-response technology can support safer independent living and reduce monitoring costs.
Who qualifies: BSW enrollment and assessed need.
How to start: Ask the case manager whether PERS is covered in the plan.
Good to know: Family caregiver payment: No
BSW Private Duty Nursing
Yes - skilled careHelps pay for: Skilled nursing at home can offset high-cost private nursing for qualifying needs.
Who qualifies: BSW enrollment, medical necessity and nursing authorization.
How to start: Ask the case manager and treating clinician about private-duty nursing.
Good to know: Family caregiver payment: Possibly if a qualified relative meets waiver and licensure/employment rules
BSW Specialized Medical Equipment & Supplies
Indirect cost offsetHelps pay for: Covered equipment, supplies and technology can reduce out-of-pocket home-care support costs.
Who qualifies: BSW enrollment, medical/functional need and authorization.
How to start: Request needed equipment through the BSW team.
Good to know: Family caregiver payment: No
BSW Non-Medical Transportation
Indirect cost offsetHelps pay for: Transportation tied to waiver goals can reduce family or private transport spending.
Who qualifies: BSW enrollment; transportation must be authorized and not duplicative of another benefit.
How to start: Ask the case manager about covered transportation.
Good to know: Family caregiver payment: No
BSW Specially Trained Attendant
YesHelps pay for: Enhanced attendant support for people with specialized needs can substitute for privately purchased care.
Who qualifies: BSW enrollment, assessed need, worker training and plan authorization.
How to start: Ask whether Specially Trained Attendant services fit the care plan.
Good to know: Family caregiver payment: Yes in limited cases under BSW rules
BSW Qualified Legally Responsible Family Caregiver
YesHelps pay for: The approved waiver permits certain qualified parents, guardians, spouses or other relatives to be paid for specified personal-care-like services when waiver criteria are met.
Who qualifies: The relative must meet qualifications; paid care must satisfy waiver criteria and authorization. A member’s authorized representative cannot also be the paid worker.
How to start: Ask the BSW case manager which services and family relationships are allowable before hiring.
Good to know: Family caregiver payment: Yes - service-specific and controlled
Montana Medicaid / CFCS-PCS
Community First Choice Services (CFCS)
YesHelps pay for: State-plan home and community personal assistance for Medicaid members who meet functional criteria; can reduce recurring private-pay aide costs.
Who qualifies: Medicaid eligibility, functional need and screening; CFCS requires nursing-home level of care.
How to start: Ask for a CFCS/PCS assessment and service authorization.
Good to know: Family caregiver payment: Sometimes through self-direction, with important exclusions
Self-Direct CFCS
YesHelps pay for: Participant or personal representative recruits, hires, trains and manages personal care attendants through the self-directed model.
Who qualifies: Must qualify for CFCS and be able to direct services personally or through an eligible representative; PCA must be an agency employee.
How to start: Request the self-directed option during CFCS enrollment.
Good to know: Family caregiver payment: Yes for many chosen workers; spouse/parent-of-minor excluded
CFCS ADL Assistance
YesHelps pay for: Bathing, dressing, grooming, toileting, eating, medication assistance, ambulation and exercise can offset private home-care hours.
Who qualifies: CFCS enrollment and assessed need; nursing-home level of care required for CFCS.
How to start: Ask the assessor to document needed ADL assistance.
Good to know: Family caregiver payment: Depends on worker relationship and self-direction rules
Self-Direct Health Maintenance Activities
Yes - selected skilled tasksHelps pay for: Self-directed participants may receive authorized skilled health-maintenance tasks such as bowel/bladder care, medication assistance and wound care.
Who qualifies: Self-direct CFCS/PCS, health-professional authorization and service-plan approval are required.
How to start: Ask the service team which health-maintenance activities can be delegated/authorized.
Good to know: Family caregiver payment: Chosen worker may provide if qualified; family exclusions still apply
CFCS Skill Acquisition & Community Integration
Yes / indirectHelps pay for: Support to learn or regain skills and participate in the community can reduce dependence on privately purchased assistance.
Who qualifies: CFCS eligibility and assessed need.
How to start: Request during assessment/service planning.
Good to know: Family caregiver payment: Depends on delivery model and worker rules
Personal Care Services (PCS)
YesHelps pay for: State-plan personal care for Medicaid members who need help with ADLs but do not necessarily meet CFCS nursing-home level-of-care criteria.
Who qualifies: Medicaid eligibility, health condition limiting ADLs and screening; PCS has different eligibility than CFCS.
How to start: Ask for a CFCS/PCS assessment and whether PCS is the correct track.
Good to know: Family caregiver payment: Sometimes through self-direction, with exclusions
PCS Essential Shopping, Housekeeping & Laundry
Yes - limited homemakerHelps pay for: Limited instrumental-ADL help can reduce paid homemaker costs.
Who qualifies: PCS eligibility and authorization; tasks must be covered and tied to assessed need.
How to start: Ask the assessor which PCS household tasks can be authorized.
Good to know: Family caregiver payment: Depends on worker relationship and self-direction rules
Self-Direct CFCS/PCS Relative or Friend Worker
YesHelps pay for: Self-direction can allow a participant to select a known worker rather than accept an agency-assigned aide.
Who qualifies: Current linked PCA policy defines excluded immediate family as a spouse and the natural/adoptive/foster parent of a minor child; other workers must meet agency/program requirements.
How to start: Verify the exact relationship with the self-direct agency before the worker starts.
Good to know: Family caregiver payment: Yes for many relatives/friends; no spouse or parent of a minor child
Montana Medicaid / Pediatric
Pediatric Complex Care Assistant (PCCA)
Yes - complex pediatric careHelps pay for: Allows trained family caregivers to deliver physician-ordered complex medical care at home for qualifying Medicaid-enrolled children.
Who qualifies: Child under 21, Montana Medicaid, qualifying complex medical condition, physician-ordered plan; caregiver must obtain Montana PCCA license and be employed by an enrolled PCCA provider agency.
How to start: Ask the child’s clinician and Medicaid team about PCCA; identify an enrolled agency and complete caregiver licensure.
Good to know: Family caregiver payment: Yes - parents, guardians, relatives and foster parents can qualify
Montana Medicaid / Home Health
Medicaid Home Health
Yes - skilled careHelps pay for: Part-time/intermittent skilled nursing and therapy in the home can offset private skilled-care costs.
Who qualifies: Medicaid eligibility, medical necessity, physician order and written plan of care reviewed at required intervals.
How to start: Ask the treating clinician to order home health and locate a Medicaid-enrolled agency.
Good to know: Family caregiver payment: No direct family wage
Medicaid Home Health Aide
YesHelps pay for: Home health aide services may be covered when medically necessary and not otherwise available through Medicaid personal assistance.
Who qualifies: Must meet Medicaid home-health requirements and service-specific criteria.
How to start: Ask the home-health agency/clinician whether aide services can be included.
Good to know: Family caregiver payment: No direct family wage
Montana Medicaid / Hospice
Montana Medicaid Hospice
Yes - hospice/home careHelps pay for: Palliative nursing, aides, counseling, medications, equipment and supplies can reduce end-of-life care costs.
Who qualifies: Medicaid eligibility, terminal illness generally with life expectancy of six months or less if illness follows normal course, hospice election and approved provider.
How to start: Ask the treating clinician or a Medicare/Medicaid-approved hospice for an eligibility evaluation.
Good to know: Family caregiver payment: No direct wage
Montana Medicaid / Transportation
Non-Emergency Medical Transportation
Indirect cost offsetHelps pay for: Mileage, commercial or specialized non-emergency transport and, in some cases, meals/lodging can reduce care-related travel costs.
Who qualifies: Montana Medicaid member; prior authorization is generally required before travel.
How to start: Call the transportation center before travel to request authorization.
Good to know: Family caregiver payment: No
Montana Medicaid / Transition
Money Follows the Person (MFP)
Indirect / transitionHelps pay for: Helps eligible Medicaid members move from a qualifying institution back to a home/community setting with transition supports.
Who qualifies: Generally 60 consecutive days in a qualifying facility, Medicaid paid at least one day, and transition into a partner waiver such as BSW, SDMI or DD with institutional level-of-care eligibility.
How to start: Submit a referral to Montana MFP and coordinate with the partner waiver.
Good to know: Family caregiver payment: No direct caregiver wage
MFP Rent, Deposit & Utility Setup
Indirect cost offsetHelps pay for: Can cover first-month rent/deposit and certain past-due rent or utility/deposit costs needed for a safe transition.
Who qualifies: MFP participant transitioning from an institution; expense must meet program transition criteria.
How to start: Include housing start-up needs in the transition plan.
Good to know: Family caregiver payment: No
MFP Household Goods & Home/Vehicle Modifications
Indirect cost offsetHelps pay for: Can help with household goods, pantry stocking, clothing and certain environmental or vehicle modifications tied to transition.
Who qualifies: MFP participation and approved transition need.
How to start: Document needed items/modifications with the transition coordinator.
Good to know: Family caregiver payment: No
MFP Overnight Supports & Technology
Yes / indirectHelps pay for: Can support overnight needs, medication-management technology and other technology that makes community living feasible.
Who qualifies: MFP participation and approved transition/service plan.
How to start: Discuss overnight and technology needs during MFP transition planning.
Good to know: Family caregiver payment: No direct wage
Montana Medicaid / I-DD
0208 Comprehensive Waiver
YesHelps pay for: HCBS for eligible people with intellectual/developmental disabilities who would otherwise need institutional services.
Who qualifies: DDP eligibility and Medicaid/waiver criteria; Montana reports a lengthy waiting list and automatically places formally eligible people on the list.
How to start: Contact DDP for eligibility and waiver-list placement; do not wait until a crisis.
Good to know: Family caregiver payment: Sometimes - qualified relatives/legal guardians may be paid for specified services
0208 Self-Directed Services
YesHelps pay for: Many 0208 services can be self-directed, giving the participant more control over workers, schedules and supports.
Who qualifies: 0208 waiver enrollment and selection of a service that permits self-direction; employer/support-broker requirements may apply.
How to start: Ask the case manager which authorized services can be self-directed.
Good to know: Family caregiver payment: Potentially, subject to service and relative-payment rules
0208 Companion
YesHelps pay for: Companion support can provide supervision, social support and assistance that may reduce private-pay caregiving.
Who qualifies: 0208 enrollment, assessed need and service authorization; self-direction is available for this service.
How to start: Request Companion during person-centered planning.
Good to know: Family caregiver payment: Yes in certain qualified-relative arrangements
0208 Personal Supports
YesHelps pay for: Personal Supports can cover assistance needed to live safely and participate at home and in the community.
Who qualifies: 0208 enrollment and approved individual plan; self-direction is available.
How to start: Ask the planning team to assess Personal Supports.
Good to know: Family caregiver payment: Yes in certain qualified-relative arrangements
0208 Respite
Yes - respiteHelps pay for: Temporary relief for family or other unpaid caregivers.
Who qualifies: 0208 enrollment and plan authorization.
How to start: Request respite in the individual plan.
Good to know: Family caregiver payment: Qualified relatives may be paid only when waiver rules permit; primary unpaid caregiver cannot simply receive the respite benefit as a stipend
0208 Environmental Modifications
Indirect cost offsetHelps pay for: Accessibility/safety changes can reduce assistance needs and avoid higher-cost settings.
Who qualifies: 0208 enrollment, documented need and authorization; self-direction is available for this service.
How to start: Request an environmental-modification assessment.
Good to know: Family caregiver payment: No
0208 Community Transition Services
Indirect cost offsetHelps pay for: One-time supports can help an eligible participant establish a home in the community.
Who qualifies: 0208 enrollment and approved transition need.
How to start: Ask the case manager about transition supports before a move.
Good to know: Family caregiver payment: No
0208 Individual Goods, Services & Specialized Equipment
Indirect cost offsetHelps pay for: Authorized goods, services, medical equipment and supplies can offset expenses needed for health, independence or community living.
Who qualifies: 0208 enrollment, person-centered need and authorization; coverage limits/criteria apply.
How to start: Document the need in the individual plan and request prior approval.
Good to know: Family caregiver payment: No
0208 Supported Employment & Transportation
Indirect / supportHelps pay for: Employment supports and transportation can reduce family transportation/supervision burden and support independence.
Who qualifies: 0208 enrollment and service-specific eligibility; some components can be self-directed.
How to start: Ask the case manager about employment and transportation supports.
Good to know: Family caregiver payment: No direct caregiver wage
0208 Qualified Relative / Legal Guardian Paid Services
YesHelps pay for: The approved waiver permits qualified relatives or legal guardians, including certain parents/guardians/spouses, to be reimbursed for specified extraordinary-care services when all safeguards are met.
Who qualifies: Relative must meet provider qualifications and waiver controls; payment cannot simply replace ordinary family responsibility.
How to start: Before hiring, have the DDP case manager verify the exact service, relationship and employer arrangement.
Good to know: Family caregiver payment: Yes - limited to specified services and extraordinary care
Montana Medicaid / Behavioral Health
SDMI HCBS Waiver
YesHelps pay for: HCBS for qualifying adults with severe and disabling mental illness who need additional supports to avoid nursing-facility placement.
Who qualifies: Age 18+, Medicaid, certified SDMI diagnosis, qualifying level of need and waiver criteria.
How to start: Contact the SDMI waiver referral channel/Mountain Pacific for screening.
Good to know: Family caregiver payment: Limited legally responsible-person payment may be available for specified extraordinary care
SDMI Self-Directed Personal Assistance
YesHelps pay for: Eligible participants may self-direct Personal Assistance as co-employers, increasing control over who provides daily support.
Who qualifies: SDMI waiver enrollment, Personal Assistance authorization and ability to participate in self-direction.
How to start: Ask the case manager to elect the self-directed model.
Good to know: Family caregiver payment: Potentially, subject to SDMI worker/LRI rules
SDMI Self-Directed Life Coach / Behavioral Intervention Assistance
Yes / supportHelps pay for: Self-directed Life Coach and Behavioral Intervention Assistance can support community stability and reduce reliance on more intensive care.
Who qualifies: SDMI waiver enrollment and authorization of the specific service.
How to start: Request the service through person-centered planning and ask about self-direction.
Good to know: Family caregiver payment: Potentially, subject to worker rules
SDMI Homemaker Chore & Meals
Yes / indirectHelps pay for: Homemaker/chore help and meals can reduce household and caregiving workload.
Who qualifies: SDMI waiver enrollment and assessed need.
How to start: Ask the case manager whether these supports fit the plan.
Good to know: Family caregiver payment: Limited LRI payment only if allowed for the specific service; do not assume
SDMI Respite
Yes - respiteHelps pay for: Temporary respite can relieve unpaid caregivers and reduce private-pay relief care.
Who qualifies: SDMI waiver enrollment and authorized respite need.
How to start: Request respite through the case manager.
Good to know: Family caregiver payment: Legally responsible individuals may be payable only under specific extraordinary-care rules
SDMI Environmental Accessibility Adaptations & PERS
Indirect cost offsetHelps pay for: Home modifications and emergency-response technology can support safer community living.
Who qualifies: SDMI waiver enrollment, assessed need and authorization.
How to start: Request through the waiver case manager.
Good to know: Family caregiver payment: No
SDMI Community Transition & Non-Medical Transportation
Indirect cost offsetHelps pay for: Transition and transportation supports can reduce costs of establishing and maintaining community living.
Who qualifies: SDMI waiver enrollment and service-plan authorization.
How to start: Discuss transition/transport needs with the case manager.
Good to know: Family caregiver payment: No
Waiver for Additional Services and Populations (WASP)
Indirect cost offsetHelps pay for: Can provide standard Montana Medicaid coverage for some low-income adults with severe and disabling mental illness who otherwise would not qualify.
Who qualifies: Age 18+, SDMI criteria and program income/eligibility rules.
How to start: Contact behavioral health or OPA for WASP screening/application.
Good to know: Family caregiver payment: No direct caregiver wage
Montana Medicaid / Work Incentive
Medicaid for Workers with Disabilities
Indirect / coverageHelps pay for: Allows qualifying workers with disabilities to keep Medicaid coverage while employed, preserving access to covered home/community services when eligible.
Who qualifies: Must meet Montana MWD disability, work, income and program rules; current thresholds should be verified in the policy manual.
How to start: Apply through Montana OPA and ask specifically for the MWD category.
Good to know: Family caregiver payment: Depends on underlying covered service
Medicare / Medicaid Cost Offset
Medicare Savings Programs (QMB / SLMB / QI)
Indirect cost offsetHelps pay for: Can pay Medicare premiums and, for QMB, qualifying Medicare cost sharing, freeing income for home-care expenses.
Who qualifies: Medicare beneficiary meeting current Montana income/resource rules for the applicable MSP.
How to start: Apply through Montana OPA and ask for MSP screening.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - limited/skilledHelps pay for: Part-time/intermittent skilled nursing, therapy and limited home-health aide care may be covered when Medicare home-health rules are met.
Who qualifies: Medicare eligibility, homebound requirement as applicable, need for qualifying skilled services and certified home-health agency.
How to start: Ask the treating clinician to certify/order home health and use a Medicare-certified agency.
Good to know: Family caregiver payment: No direct family wage
Medicare Hospice
Yes - hospiceHelps pay for: Hospice can cover palliative home visits, aides, drugs, equipment and supplies related to a terminal illness.
Who qualifies: Medicare hospice eligibility and election requirements; generally terminal prognosis of six months or less if illness runs its normal course.
How to start: Request a hospice evaluation from a Medicare-certified hospice.
Good to know: Family caregiver payment: No direct family wage
Medicare / Prescription Cost Offset
Extra Help (Part D Low-Income Subsidy)
Indirect cost offsetHelps pay for: Reduces Medicare Part D premiums, deductibles and copays, preserving household funds for caregiving.
Who qualifies: Medicare and current federal income/resource or automatic-eligibility rules.
How to start: Apply through Social Security or ask SHIP for screening help.
Good to know: Family caregiver payment: No
Medicare Counseling
Montana SHIP
Indirect cost offsetHelps pay for: Free Medicare counseling can identify Medicare Savings, Extra Help, Part D, Medicare Advantage and other ways to reduce health costs.
Who qualifies: Available to Medicare beneficiaries and caregivers; counseling is free. Home visits may be available for homebound clients.
How to start: Call Montana SHIP for an individualized benefits review.
Good to know: Family caregiver payment: No
Montana Prescription Cost Offset
Big Sky Rx
Indirect cost offsetHelps pay for: Pays all or part of an eligible Medicare beneficiary’s Medicare-approved prescription drug plan premium, reducing monthly expenses.
Who qualifies: Montana resident with Medicare who meets current Big Sky Rx income rules; current materials state assets are not counted for Big Sky Rx.
How to start: Apply to Big Sky Rx or ask a SHIP/AAA counselor for help.
Good to know: Family caregiver payment: No
Montana Aging Network
AAA / ADRC Information & Assistance
Indirect / navigationHelps pay for: Local aging/disability navigators can connect families to home care, homemaker help, meals, transportation, respite, benefits and legal/utility resources.
Who qualifies: Older adults, adults with disabilities and caregivers; individual program eligibility varies.
How to start: Call the statewide aging line and ask for the local AAA/ADRC.
Good to know: Family caregiver payment: No
Home-Delivered Meals
Indirect cost offsetHelps pay for: Meals delivered to eligible homebound older adults can reduce meal-preparation workload and food costs.
Who qualifies: Generally older adults unable to travel to a congregate meal site; local AAA/provider assessment and contribution rules apply.
How to start: Call the local AAA or nutrition provider for assessment.
Good to know: Family caregiver payment: No
ADRC Options Counseling
Indirect / planningHelps pay for: Free options counseling can compare home-care, waiver, caregiver, housing and financial-support paths and help develop action steps.
Who qualifies: Available regardless of income or financial assets; program eligibility for resulting services varies.
How to start: Ask the local ADRC for Options Counseling.
Good to know: Family caregiver payment: No
Montana Caregiver Support
TCARE / National Family Caregiver Support
Indirect / respite supportHelps pay for: Caregiver assessment, individualized support planning, counseling, education and connections to respite can reduce caregiver burnout and out-of-pocket support costs.
Who qualifies: Caregiver and care-recipient circumstances must fit local aging-network program rules; services vary by area and funding.
How to start: Ask the local AAA for TCARE/family caregiver support assessment.
Good to know: Family caregiver payment: No regular wage to caregiver
Alzheimer’s / Dementia Caregiver Respite
Yes - respiteHelps pay for: Aging-network respite resources can provide temporary relief for caregivers of people with Alzheimer’s disease or related dementia.
Who qualifies: Local program/funding eligibility and availability apply.
How to start: Call the local AAA and ask specifically about dementia respite.
Good to know: Family caregiver payment: No direct wage to the primary unpaid caregiver
Montana Lifespan Respite Voucher Program
Yes - respiteHelps pay for: When funding is available, respite vouchers can help high-stress family caregivers purchase a break from caregiving.
Who qualifies: Caregiver/care-recipient must meet current voucher criteria; funding and availability can change.
How to start: Review the current voucher application and local respite-provider options.
Good to know: Family caregiver payment: Pays respite expense; do not assume the primary caregiver can be paid
Household Cost Offset
SNAP
Indirect cost offsetHelps pay for: Food assistance can free household income for uncovered home-care expenses.
Who qualifies: Household must meet current SNAP eligibility rules.
How to start: Apply through Montana OPA or the state benefits portal.
Good to know: Family caregiver payment: No
Low Income Home Energy Assistance Program (LIEAP)
Indirect cost offsetHelps pay for: Helps eligible households with heating/energy costs, preserving funds for care.
Who qualifies: Income and household rules apply; seasonal/program funding rules change.
How to start: Apply through the local energy assistance office/combined application.
Good to know: Family caregiver payment: No
Weatherization Assistance Program
Indirect cost offsetHelps pay for: Energy-efficiency work such as insulation, weatherstripping and heating-system improvements can lower ongoing utility costs and improve home safety.
Who qualifies: Income eligibility and home assessment; older adults and people with disabilities are among priority groups.
How to start: Use the combined LIEAP/Weatherization application through the local provider.
Good to know: Family caregiver payment: No
Tax / Housing Cost Offset
Montana Elderly Homeowner/Renter Income Tax Credit
Indirect cost offsetHelps pay for: Refundable state income-tax credit can offset housing costs and free funds for care; current DOR materials list a maximum credit of $1,150.
Who qualifies: Generally age 62+ with Montana residency/occupancy and household income within the current limit; tax filing is required to claim.
How to start: Review DOR eligibility and file the required Montana return/credit form.
Good to know: Family caregiver payment: No
Property Tax Assistance Program (PTAP)
Indirect cost offsetHelps pay for: Reduces the property-tax rate for qualifying homeowners on fixed or limited income, lowering recurring housing costs.
Who qualifies: Must own/occupy qualifying Montana property and meet current income/application rules; 2026 reduction percentages vary by income band.
How to start: Apply to Montana Department of Revenue by the applicable deadline.
Good to know: Family caregiver payment: No
VA Benefits
VA Homemaker & Home Health Aide
YesHelps pay for: VA may authorize community-based aides to help an eligible Veteran with ADLs and selected daily tasks at home.
Who qualifies: VA health care eligibility, clinical need, authorization and local availability; copays may apply. Ask the Veteran’s VA primary care/social work team for assessment and authorization.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide.
Good to know: Family caregiver payment: No
Veteran-Directed Care
YesHelps pay for: Flexible self-directed budget for eligible Veterans needing personal care; Veteran can choose workers and services within local program rules.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local Veteran-Directed Care availability. Ask the VA care team whether VDC is available in the Veteran’s Montana service area.
How to start: Ask the VA social worker or care team about Veteran-Directed Care.
Good to know: Family caregiver payment: Yes - family/friends may often be hired subject to local rules
VA Skilled Home Health
Yes - skilled careHelps pay for: VA may purchase skilled nursing, therapy and related home-health services from authorized community providers.
Who qualifies: Clinical need, VA eligibility/authorization and provider availability. Request through the VA care team.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No
VA Respite Care
Yes - respiteHelps pay for: VA may provide in-home, adult-day or facility respite to give caregivers a break.
Who qualifies: VA enrollment, clinical need and local availability/authorization. Ask VA social work or caregiver support about respite.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No direct wage
VA Home-Based Primary Care
Yes - clinical home careHelps pay for: Interdisciplinary VA primary care delivered in the home for eligible Veterans with complex chronic conditions who have difficulty traveling.
Who qualifies: VA enrollment, clinical eligibility and local program availability. Ask the VA primary care team for HBPC screening.
How to start: Ask the VA social worker or care team about VA Home-Based Primary Care.
Good to know: Family caregiver payment: No
VA Adult Day Health Care
Indirect / day careHelps pay for: Daytime health, rehabilitation and social services can reduce caregiver hours and delay institutional placement.
Who qualifies: VA eligibility, clinical need and local availability. Ask VA social work about adult day health options.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Yes - caregiver stipend/supportHelps pay for: May provide eligible family caregivers education, support, health coverage in some cases and a monthly stipend.
Who qualifies: Veteran and caregiver must meet current PCAFC eligibility, service-connected disability and personal-care need rules. Apply through VA Caregiver Support / PCAFC.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes - qualifying primary family caregiver may receive stipend
VA Aid & Attendance / Housebound Pension
Yes - cash benefit can be used toward careHelps pay for: Additional monthly pension amount can help an eligible wartime Veteran or survivor pay for personal care and other needs.
Who qualifies: Must qualify for VA Pension or Survivors Pension and meet Aid & Attendance or Housebound criteria. Apply through VA or an accredited Montana VSO; document care needs and expenses.
How to start: Ask the VA social worker or care team about VA Aid & Attendance / Housebound Pension.
Good to know: Family caregiver payment: Indirect - Veteran/survivor controls funds
VA Medical Foster Home
Residential alternativeHelps pay for: Small-home residential alternative paired with VA Home-Based Primary Care for Veterans needing substantial assistance.
Who qualifies: VA clinical eligibility, local availability and payment arrangement; not the same as staying in one’s own home. Ask VA social work/HBPC about Medical Foster Home availability.
How to start: Ask the VA social worker or care team about VA Medical Foster Home.
Good to know: Family caregiver payment: No
VA Montana Caregiver Support Program
Indirect / navigationHelps pay for: Local VA caregiver team provides education, coaching, respite navigation, PCAFC/PGCSS assistance and connections to VA/community services.
Who qualifies: Caregiver of an enrolled Veteran; specific benefits have separate eligibility rules. Contact the VA Montana Caregiver Support team.
How to start: Ask the VA social worker or care team about VA Montana Caregiver Support Program.
Good to know: Family caregiver payment: PCAFC may pay qualifying caregivers
Montana Disabled Veteran Property Tax Assistance
Indirect cost offsetHelps pay for: Reduces property tax for qualifying Montana homes owned by certain disabled Veterans or eligible surviving spouses, freeing funds for care.
Who qualifies: Montana Department of Revenue disability, ownership, occupancy and income rules apply. Ask a Montana VSO/DOR about the Disabled Veteran program and current application rules.
How to start: Ask the VA social worker or care team about Montana Disabled Veteran Property Tax Assistance.
Good to know: Family caregiver payment: No
Montana Veterans Affairs Division / Accredited VSO Assistance
Indirect / navigationHelps pay for: Free accredited benefits assistance can identify VA pension, compensation, caregiver, health and state veteran benefits that offset care costs.
Who qualifies: Veteran, survivor or family member seeking benefits assistance. Contact a Montana Veterans Affairs Division service officer.
How to start: Ask the VA social worker or care team about Montana Veterans Affairs Division / Accredited VSO Assistance.
Good to know: Family caregiver payment: No direct wage
Where Montana Families Can Start
Not sure where to begin? Match your situation to a contact below.
Statewide aging, caregiver, meals, respite, SHIP and local service navigation
Montana Aging Services / Area Agencies on Aging
Long-term-services options counseling and help connecting to home/community supports
Aging & Disability Resource Centers (ADRC)
Medicaid, SNAP, Medicare Savings and other public-benefit applications
Montana Office of Public Assistance
Medicaid coverage questions, provider/service navigation and member assistance
Montana Healthcare Programs Member Services
BSW referral, level-of-care screening and waiver access
Big Sky Waiver / Mountain Pacific
CFCS/PCS program and self-directed personal-care questions
Community First Choice Services / Personal Care Services
0208 waiver eligibility, waiting list, self-direction and regional-office referral
Developmental Disabilities Program (DDP)
PCCA coverage questions and help locating Medicaid-enrolled services
Pediatric Complex Care Assistant (PCCA)
Institution-to-community transition referral and transition supports
Money Follows the Person
VA caregiver support, respite navigation, PCAFC and caregiver programs
VA Montana Caregiver Support
Accredited Veteran benefits help and Montana Veteran programs
Montana Veterans Affairs Division
Before You Rely on Any Payment Source
Planning Point
Why It Matters
Big Sky Waiver is the primary aged/physical-disability HCBS waiver, but access is not immediate
Montana’s current BSW page states that there are waiting lists. Put an eligible person on the list early while also screening state-plan CFCS/PCS and other supports that do not rely on the same waiver slot.
Big Sky can pay some legally responsible relatives, but only under controlled service rules
The approved waiver allows specified qualified relatives, parents, guardians and spouses to be reimbursed for certain personal-care-like services when waiver criteria are met. Verify the exact service, worker qualification and representative status before hiring.
Do not treat the proposed 2026 Big Sky amendment as current authority until Montana/CMS make it effective
The current BSW program page still anchors to the approved waiver effective July 1, 2024 and separately lists a 2025-26 amendment for public review. This workbook therefore uses the approved waiver for current caregiver-payment rules.
CFCS/PCS can be an important route while someone waits for BSW
CFCS and PCS are Medicaid state-plan personal-care programs with agency and self-directed delivery models. CFCS requires nursing-home level of care, while PCS has different functional eligibility, so screen both rather than assuming a waiver is the only route.
Self-directed CFCS/PCS does not mean every family member can be paid
The current linked PCA policy excludes a spouse and the natural, adoptive or foster parent of a minor child from reimbursement. Other relatives or friends may be selectable if they meet agency/program rules, so verify the exact relationship before relying on payment.
PCCA is a major Montana-specific paid-family-caregiver pathway for medically complex children
PCCA allows trained parents, guardians, relatives and foster parents to perform physician-ordered complex medical tasks for an eligible Medicaid child under 21, but the caregiver must be licensed and employed by an enrolled provider agency. Provider availability can still affect access.
The 0208 Comprehensive Waiver has a lengthy waiting list
DDP says formally eligible people are placed on the 0208 waiting list. Establish DDP eligibility early and use available case management/state-plan supports while waiting rather than waiting for a crisis.
0208 self-direction and family payment are service-specific
Many 0208 services can be self-directed, and the approved waiver permits some qualified relatives/legal guardians to be paid for extraordinary care. The exact service, qualifications and safeguards determine whether a specific family worker can be paid.
SDMI HCBS has its own self-direction and legally responsible-person rules
The SDMI waiver allows self-direction for Personal Assistance, Life Coach and Behavioral Intervention Assistance, while separate policy permits limited payment to a spouse/legal guardian for specified extraordinary care. Do not import BSW or 0208 family-pay rules into SDMI.
Money Follows the Person is a transition pathway, not a general home-care benefit
MFP is designed for people leaving qualifying institutional settings and requires connection to a partner waiver plus institutional-level-of-care criteria. Its one-time housing, household, modification and technology supports can be very valuable during transition.
2026 Medicaid Expansion community-engagement rules are not the same as aged/disabled HCBS eligibility
Montana began new 2026 requirements for many expansion adults. Aged, disabled, waiver and Medicare-related Medicaid categories have separate eligibility rules, so identify the correct Medicaid category before applying the new expansion requirements.
Montana Veterans should layer VA benefits with state and Medicaid options
Montana is in VA Community Care Network Region 4, administered by TriWest. Screen VA Homemaker/HHA, Veteran-Directed Care, respite, PCAFC, Aid & Attendance and the Montana disabled-veteran property-tax program alongside non-VA home-care funding.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in Montana to help you navigate the application process.
← Back to How to Pay for In-Home Care