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 qualified seniors who would normally require care only accessible in a nursing home setting but wish the residents 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 Services oversees the waiver.

Services

Services included in 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 Chores, 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

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 that assists the State with the administration of the Big Sky program.
  2. Financial: The applicant can meet the financial requirements if they are already eligible for standard Medicaid. Certain asset and income limits apply if an applicant is not already a Medicaid beneficiary. For 2022, the income limit for an individual is $841, and for a married couple, the limit is $1,682.  The asset limit is $2,000 individually or $4,000 if both applicants are married. The state does not allow an individual to create a Miller Trust. It requires an applicant with 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 nor in an institution. The community spouse’s assets must be considered in the eligibility determination, known as the Community Spouse Resource Allowance (CSRA). In 2022, the maximum allowable CSRA is $137,400, 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 2022, the PNA was a minimum of $2,177. These asset rules allow the community spouse to provide for himself 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. As of 2020, there was a waiting list to participate in the program.  Priority is given to those with the greatest needs for services.

Conclusion

Montana’s status as a “medically needy” state means 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.

Access all state Medicaid Waiver pages.