Montana Assisted Living and In-Home Care Resources for 2017


Montana provides long-term care resources to seniors through the Montana Department of Health and Human Services (DPHHS), Senior and Long-Term Care Division. Many programs are available by contacting your local Area Agency on Aging (AAA) which provides services under the Older Americans Act to seniors over 60 years of age.

The DPHHS also administers a Medicaid Home and Community Based Waiver (HCBS) Waiver program, called “Montana Big Sky,” which is available to qualifying seniors who would normally require care only accessible in a nursing home setting but wish the reside in their community or stay in their own home.

Medicaid Waiver Program for Assisted Living and In-Home Care

Montana Big Sky Medicaid Waiver (HCBS “Montana Big Sky” Waiver)

The Montana Big Sky HCBS Medicaid Waiver, or “Montana Big Sky,” program provides seniors over the age of 65 who meet certain financial and health criteria to live in their own homes or assisted living community rather than a nursing home. The program is available to those who would otherwise require a nursing home level of care but choose to remain in a more independent and comfortable setting. The Community Services Bureau of the Senior and Long Term Care Division, Department of Health and Human Servicesoversees the waiver.


Services includedin the Montana Big Sky program include: Adult Day Health, Case Management, Community Supports,, Community Transition, Consultative Clinical and Therapeutic Services, Consumer Goods and Services, Day Habilitation, Dietetic Services, Environmental Accessibility Adaptations, Family Training and Support, Financial Management Service, Health and Wellness, Homemaker,Homemaker Chore, Independence Advisor, Non-Medical Transportation, Nutrition, Occupational Therapy, Pain and Symptom Management, Personal Assistance Services, Personal Emergency Response System, Physical Therapy, Post-Acute Rehabilitation Services, Prevocational Services, Private Duty Nursing, Residential Habilitation, Respiratory Therapy, Respite Care, Senior Companion, Specialized Medical Equipment and Supplies, Speech Therapy and Audiology, Supported Employment, Supported Living, and Vehicle Modification. Additional services may be added to the Montana Big Sky program if the Department of Health and Human Services, Senior & Long Term Care Division, Community Services Bureau.


Eligibility for Montana Big Sky requires, among other criteria, residency in the state and certain financial and healthcare requirements.

  1. Health: The applicant must require a nursing home level of care, as determined by a pre-admission screening conducted by Mountain Pacific Quality Health, a nonprofit which assists the State with administration of the Big Sky program.
  2. Financial: The applicant can meet the financial requirements if they are already eligible for standard Medicaid. If an applicant is not already a Medicaid beneficiary, certain asset and income limits apply. For 2017, the income limit for an individual is $2,205 and the asset limit is $2,000 individually, or $3,000 if both applicants are married. The state does notallow an individual to create a Miller Trust, and requires an applicant who has too much income to use their income for medical or remedial care to bring their income under the limit for eligibility, this is known as the “medically-needy” requirement. Montana also has asset requirements and limits for the spouse of a married applicant (or “community spouse”), if the spouse is neither enrolled in the Montana Big Sky Waiver or in an institution. The assets of the community spouse must be considered in the eligibility determination, known as the Community Spouse Resource Allowance (CSRA). In 2017, the maximum allowable CSRA is $120,900, meaning that anything over that amount is factored into the applicant’s asset limit. In addition, Montana allows for personal needs allowance (PNA, or the MMMNA) and a housing allowance. For 2017, the PNA was a minimum of $2,205 and a maximum of $3,022.50, and the housing allowance was $600.75. These asset rules allow the community spouse to provide for his or herself while the applicant is receiving benefits under the Montana Big Sky program.

Practical Considerations

Montana is a “medically-needy” state, meaning, in order to meet the resource, or asset, limit required to be eligible for Medicaid, an applicant is allowed to spend down their money on medical and remedial care in order to qualify for assistance under the income and asset limits. Additionally, Montana does not apply an individual cost limit when determining whether to deny an otherwise-eligible applicant into the Montana Big Sky program. The number of available slots for eligible applicants to Montana Big Sky is 2,580 for 2017, and tops out at 2,606 for years 2018-2020. In addition to the limited number of slots, there are wait list criteria to determine when an eligible applicant transitions from the waitlist into the program.


Montana’s status as a “medically-needy” statemeans that in order to become eligible for Medicaid if you don’t already meet the income and asset limits, you may need to spend some of your money before becoming eligible. However, Medicaid planning strategies may help you save income and assets if you have too much to qualify under the limits but are already spending money on both routine and remedial health care costs.