Montana Medicaid's Community First Choice and Personal Care Services pay personal care attendants, and adult children and other relatives may be eligible to be that paid attendant. Of Montana's two benefits, only Community First Choice Services can pay a spouse, and only under DPHHS's legally responsible individual rules, which center on extraordinary care and generally cap paid hours at 40 a week. Montana Community First Choice family caregiver pay runs through a provider agency, which processes the payroll and withholds the taxes.

In This Guide

Which Family Caregivers Can Be Paid Through Montana's Community First Choice?

Community First Choice is the federal 1915(k) option, and in Montana it runs as Community First Choice Services (CFCS) and Personal Care Services (PCS), the state plan personal care benefit that Montana Medicaid renamed from Community First Choice and Personal Attendant Services (CFC/PAS). DPHHS treats a spouse as a legally responsible individual (LRI), with separate rules.

Your relationship Can you be paid?
Adult child or other relative Yes, may be eligible under CFCS or PCS
Spouse, member qualifies for CFCS Only if the LRI rules are met (see below)
Spouse, member on PCS only No; ask for a re-screening into CFCS
Relative who lives with the member Not stated in the sources we cite; ask the program
Guardian of an adult, or power of attorney Not stated in the sources we cite; ask the program

The Rules for Paying a Spouse

Being told "spouses can't be paid" when you're the one doing the bathing, lifting and night checks is hard to hear. Montana's rule is narrower than that. DPHHS says a spouse or a parent of a minor child can be paid as a PCA under CFCS only if all of these hold:

  • Extraordinary care: the care must exceed what is normally expected of a spouse.
  • Hours: under Montana CFCS, paid LRIs are generally capped at 40 hours per week.
  • No dual roles: an LRI can't be the paid caregiver and the personal representative (PR) at the same time.
  • Necessity: the Department must determine that using an LRI is necessary to protect the member's health and welfare or to keep them out of a nursing home.

Montana's rule, ARM 37.40.1002(12), also allows payment for care that isn't extraordinary when the member can't get an attendant who isn't legally responsible because of geographic, cultural or other factors limiting availability, and paid spouse care has to be for the member's own needs, not household chores. Our Montana spouse guide covers the functional assessment and PCS re-screening.

Does Your Parent Qualify for CFCS or PCS?

To be eligible for Montana CFCS or PCS, the person receiving care must have a health condition that limits their ability to perform activities of daily living, take part in the screening process, and be eligible for Medicaid. To qualify for CFCS specifically, they must also meet a nursing home level of care; PCS doesn't require it.

Under self-directed CFCS/PCS, the member or their personal representative hires, trains and manages the attendants. For financial limits, see how to apply for Montana Medicaid.

How Many Hours Can a Family Caregiver Be Paid For?

Before you cut back at another job, know the ceiling: Montana's self-direction policy (SD-CFC/PAS 404, October 1, 2018) caps a member at no more than 84 hours of Community First Choice and no more than 80 hours of Personal Attendant Services in a two-week period, and allows hours above that limit for less than 90 days.

Montana's 2015 live-in policy (SD-CFC/PAS 711) says the program supports live-in family members but doesn't replace them, and household tasks done as part of the shared living environment won't be authorized. Montana also requires Electronic Visit Verification (EVV) for all CFCS and PCS members, including those with a live-in caregiver.

What Montana Community First Choice Family Caregiver Pay Looks Like

Estimate based on home care aide wages: the median hourly wage for home health and personal care aides in Montana was $17.61 in May 2025, according to the Bureau of Labor Statistics. Ask your agency what it pays before you budget.

How to Get Hired as the Paid Attendant

1
Step 1

Apply for Montana Medicaid if your parent isn't enrolled

Apply at apply.mt.gov, through the Public Assistance Helpline at 1-888-706-1535, or at a local Office of Public Assistance.

2
Step 2

Call the CFCS/PCS program

at 406-444-4564 and ask for the self-directed option.

3
Step 3

Complete the screening

Your parent takes part in the screening process; CFCS also requires a nursing home level of care.

4
Step 4

Name the caregiver

Under self-direction, your parent or their PR chooses who to hire. A spouse has to meet the LRI rules above.

5
Step 5

Clear the agency's pre-employment checks, then log every shift through EVV

Is CFCS Pay Taxable?

It may be. IRS Notice 2014-7 covers Medicaid 1915(c) waiver payments, and Montana's CFCS is a 1915(k) state plan benefit instead., For other programs, the IRS says excludability "will depend on the nature of the payments and the purpose and design of the program," so confirm with a tax professional. See whether Medicaid caregiver payments are taxable and Montana caregiver programs.

Frequently Asked Questions

I'm my mother's guardian. Can I still be her paid attendant?

The sources we cite don't say whether a guardian or power of attorney holder can be the paid attendant. For a member under guardianship, Montana's CFCS/PCS policy says the appointed guardian should act as the personal representative, and a PR isn't paid for PR duties. Ask the CFCS/PCS program at 406-444-4564 before you count on the income.

When did Montana start allowing paid spouses under Community First Choice?

Montana DPHHS gave public notice that, effective May 12, 2023, the CFC State Plan would be amended to make LRI use a permanent flexibility for members who need extraordinary care, and the current rule text, Administrative Rules of Montana 37.40.1002(12), took effect January 11, 2025.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in MontanaMontana's CFCS/PCS and Big Sky Waiver can pay family caregivers in 2026; veterans' families can add PCAFC, Veteran-Directed Care, and Aid and Attendance. CaregiverHow to Get Paid to Care for Your Spouse in MontanaCan Montana pay you to care for your spouse? Medicaid can, mostly for extraordinary care, generally up to 40 hours a week. VA can pay a veteran's spouse too. CaregiverMontana Caregiver ProgramsMontana caregiver programs for 2026: who Medicaid can pay (relatives yes, spouses mostly for extraordinary care), NFCSP respite, VA stipends, and taxes. MedicaidMontana Medicaid HCBS WaiversMontana Medicaid HCBS waivers pay for home and community care through the Big Sky Waiver for people who meet a nursing-facility level of care. Here's how. MedicaidHow to Apply for Montana MedicaidApply for Montana Medicaid online, by phone, by mail, or in person. Covers medically needy spend-down, documents, timelines, and how to appeal a denial.

Find personalized help getting hired as a paid attendant through Montana's Community First Choice at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.