Montana Medicaid Waivers & Home and Community Based Programs Overview

Montana, known as The Treasure State, has a well-structured Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.

Administered by the Montana Department of Public Health and Human Services (DPHHS), Senior and Long-Term Care Division (SLTC), and the Developmental Disabilities Program (DDP), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings instead of institutional care.

Key waiver programs include the Big Sky Waiver (BSW), which provides personal care, respite, and case management services for seniors and adults with physical disabilities, and the 1915(c) Home and Community-Based Waiver for Individuals with Developmental Disabilities (DD Waiver), which offers residential, habilitative, and employment support for individuals with intellectual and developmental disabilities (IDD). Additional programs include the Self-Directed Personal Assistance Services (PAS) Waiver, the Medically Fragile Children’s Waiver, and the Severe Disabling Mental Illness (SDMI) Waiver, all of which promote independent living and community integration. Montana also places a strong emphasis on Self-Directed Services, allowing waiver participants to manage their care and hire their own caregivers.

Regulatory oversight in Montana is managed through DPHHS, SLTC, and DDP, with additional licensing and compliance enforcement handled by the Quality Assurance Division (QAD). Montana operates under both fee-for-service and managed care models, ensuring that HCBS services are accessible across the state, including in rural and tribal communities. The state has also implemented Electronic Visit Verification (EVV) for personal care services, enhancing compliance and accountability in home-based care programs.

Providers must navigate Medicaid enrollment, prior authorization requirements, and stringent reporting measures to successfully participate in Montana’s HCBS system. With a strong focus on rural healthcare access, person-centered planning, and cost-effective service delivery, Montana’s Medicaid waiver programs ensure that individuals receive high-quality, community-based supports while maintaining independence, dignity, and active engagement in their local communities.

---

Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.

Browse Policy & Procedure Manual for This State's Programs and Services