Montana Medicaid pays for in-home personal care and related services through 2 programs, including the Big Sky Waiver (BSW) and the DDP 0208 Comprehensive Waiver. DPHHS Senior and Long-Term Care Division runs BSW and CFCS/PCS; the Developmental Disabilities Program runs the 0208 waiver. Full EVV compliance has been required since dates of service on and after 2024-07-01, and claims that bypass Mobile Caregiver+ are denied. The program was renamed from CFC/PAS to CFCS/PCS.
Yes. Community First Choice Services (1915(k), requires nursing home level of care) and Personal Care Services cover help with ADLs, and PCS adds limited grocery shopping, housekeeping and laundry; both are offered agency-based or self-directed.
Which Montana waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Big Sky Waiver (BSW)
Population
Medicaid-eligible people who meet nursing facility level of care and have an unmet need only waiver services can resolve; there is a waiting list.
Services covered
personal assistance
homemaker
respite care
adult day health
adult residential living
case management
transportation
private duty nursing
environmental adaptations
Billing format
Claims for EVV-covered services must have a compliant EVV record and be submitted through Netsmart Mobile Caregiver+, the state EVV aggregator.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.
