How to Get Paid as a Family Caregiver in Montana (2026)

If you are figuring out how to get paid as a family caregiver in Montana, the answer runs through Montana Medicaid and the VA system. Montana Medicaid's Community First Choice Services and Personal Care Services (CFCS/PCS) has a self-direct option in which the member or their personal representative hires, trains, and manages their own attendants.1 DPHHS says adult children and other relatives may be eligible to be paid as an attendant, while a spouse can be paid only under CFCS, not PCS alone, and generally only for extraordinary care.2 For veteran families, VA programs add separate routes to compensating a family caregiver.

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to an eligible veteran's approved Primary Family Caregiver, and a spouse can serve as that caregiver.3 VA Aid and Attendance raises the 2026 maximum annual pension rate to $34,488 for a veteran with one dependent, a ceiling: VA bases the payment on the difference between the claimant's income for VA purposes and that maximum.4

The Short Version

If the care recipient is a veteran, start with VA. PCAFC pays an approved Primary Family Caregiver a monthly stipend, and a spouse can be that caregiver.3 Veteran-Directed Care gives the veteran a flexible budget, and VA says the aides a veteran hires might include a family member.7 Aid and Attendance adds monthly payments to a VA pension for veterans and survivors already on that pension who meet one of VA's listed needs, such as needing help with daily activities.3

If the care recipient qualifies for Montana Medicaid and for CFCS/PCS, the Self-Direct option lets the member hire and manage their own attendants.1 DPHHS says adult children and other relatives may be eligible to be paid; a spouse can be paid under CFCS but not PCS alone, generally only for extraordinary care.2

If neither VA benefits nor Medicaid applies, a private arrangement between family members is the fallback. Montana Medicaid looks back 60 months at resource transfers, so get advice before paying a relative if Medicaid may be needed later.8

What Montana Offers

Community First Choice Services and Personal Care Services (CFCS/PCS)

Montana's Medicaid personal care benefit was renamed from Community First Choice and Personal Attendant Services (CFC/PAS) to Community First Choice Services and Personal Care Services (CFCS/PCS) to match federal naming. To be eligible for CFCS and PCS, a person 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, a person must also meet a nursing home level of care.1

Eligible members choose between agency-based services and Self-Direct CFCS/PCS. Under self-direction, the member or their personal representative is responsible for hiring, training, and managing their personal care attendants.1

DPHHS's self-direction guide says adult children and other relatives may be eligible to be paid as a personal care attendant under CFCS/PCS. A spouse is a legally responsible individual (LRI) and can be paid only under CFCS, not PCS alone, and only if the LRI rules are met: the care must exceed what is normally expected of a spouse, the Department must find that using the spouse is necessary for the member's health and welfare or to avoid a move to a nursing home, paid LRIs are generally capped at 40 hours a week, and a spouse cannot be the paid caregiver and the personal representative at the same time. Montana's rule also allows pay for care that is not extraordinary when the member cannot get another attendant because of geographic, cultural, or other factors. A member on a PCS-only plan who wants to hire a spouse must request a re-screening to see whether they now meet the nursing home level of care CFCS requires.2 The CFCS/PCS provider agency processes payroll, withholds taxes, and runs the pre-employment checks.2

For CFCS/PCS questions, the program contact DPHHS lists is 406-444-4564, and the Montana DPHHS Senior and Long Term Care Division is at (406) 444-4077.1

Big Sky Waiver

Montana's home and community-based waiver for older adults is the Big Sky Waiver, which operates under Section 1915(c) of the Social Security Act.9 It serves people age 65 or older, and people ages 0 to 64 with physical or other disabilities, who meet a nursing facility level of care, so they can live at home instead of in an institution. To qualify, a person must be financially eligible for Medicaid, meet the minimum level of care for nursing facility placement, and have an unmet need that only Big Sky Waiver services can resolve. DPHHS says there are currently waiting lists.1 Big Sky Waiver members can get some types of in-home care from a relative or a legally responsible individual such as a spouse, who must be employed as a personal care worker by a provider agency, or by the member if the member self-directs.10

NFCSP Through Montana's Area Agencies on Aging

The National Family Caregiver Support Program reaches Montana families through DPHHS's partnerships with nine Area Agencies on Aging. Its grantees provide information about services, help getting access to them, individual counseling, support groups and caregiver training, respite care, and limited supplemental services.1

NFCSP serves adult family members and other informal caregivers of people 60 or older, caregivers of people of any age with Alzheimer's disease or a related disorder, relatives age 55 or older (not parents) caring for children under 18, and relatives age 55 or older, including parents, caring for adults ages 18 to 59 with disabilities. Federal law sets conditions on those older relative caregivers: the relative must live with the child or adult with a disability, provide their in-home and community care informally, and be their primary caregiver. A relative caring for a child must also be the primary caregiver because the parents are unable or unwilling to be, and must have a legal relationship to the child, such as custody, adoption, or guardianship, or be raising the child informally.5

Respite care and supplemental services carry an extra condition under federal law: for a family caregiver of an older person, that person must be unable to perform at least two activities of daily living without substantial help, or, because of a cognitive or other mental impairment, need substantial supervision because they behave in a way that poses a serious health or safety hazard.5

To find your local Area Agency on Aging, use the Eldercare Locator online or call or text 1-800-677-1116.11

The Six Ways to Get Paid as a Family Caregiver in Montana

Pathway 1: Self-Direct CFCS/PCS

For Medicaid-eligible Montanans who qualify for CFCS or PCS, the Self-Direct option puts hiring in the member's hands.1 An adult child or other relative may be eligible to be the paid attendant; a spouse only under CFCS, under the LRI rules above.2

Pathway 2: Big Sky Waiver

If the person you care for meets a nursing facility level of care and has an unmet need that only Big Sky Waiver services can resolve, ask about the Big Sky Waiver. Referrals go to Mountain Pacific Quality Health at 1-800-219-7035, and eligibility specialists at the County Office of Public Assistance determine Medicaid financial eligibility separately. Expect a waiting list.1 Once enrolled, the member can get some in-home care from a relative; a spouse can be paid only for care beyond usual responsibilities that a qualified professional finds is in the member's best interest, up to 40 hours in a 7-day period. A family member who is also the member's representative may not be paid.10

Pathway 3: VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a designated Primary Family Caregiver of an eligible veteran.12 The caregiver must be at least 18 and either a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or someone who lives full time with the veteran or is willing to.3

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:3

• A VA disability rating, individual or combined, of 70 percent or higher.3
• Discharge from the U.S. military, or a date of medical discharge.3
• A need for at least six months of continuous, in-person personal care services.3
• Enrollment in VA health care.3

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process:3

• Participating in the program is in the veteran's best interest.3
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.3
• The veteran receives care at home, or will do so if VA designates a family caregiver.3
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.3

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.3

The monthly stipend starts from the OPM General Schedule grade 4, step 1 annual salary for the veteran's geographic locality, divided by 12. That monthly base is then multiplied by a factor, and 38 CFR 71.40(c)(4)(i) sets five rungs using three distinct factors (0.625, 1.00, and 0.25) across two schedules.3 Which schedule applies depends on whether the veteran is in the current program or is a legacy participant or applicant:12

• Current program (the veteran meets 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community."12
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor is set instead by the sum of the veteran's 2019 clinical ratings, 1.00 for a sum of 21 or higher, 0.625 for a sum of 13 to 20, and 0.25 for a sum of 1 to 12. No "unable to self-sustain" determination is required on this route.12

A veteran who meets both the current and the legacy criteria is paid whichever of the two amounts is higher, so a legacy household rated 21 or higher reaches the full 1.00 factor on the rating sum alone. A legacy participant's stipend also cannot drop below what the caregiver was eligible to receive the day before October 1, 2020, while the veteran stays at the address on record. The legacy schedule runs for eight years from October 1, 2020, so it lapses October 1, 2028.12

VA treats the monthly stipend as a non-taxable benefit, similar to veteran disability payments.6 The stipend is paid only once the caregiver is enrolled in direct deposit through the VA customer engagement portal. Primary Family Caregivers can also receive at least 30 days of respite care a year, and CHAMPVA health coverage if they do not already qualify for care under another health care plan.12 Both Primary and Secondary Family Caregivers can receive caregiver education and training and mental health counseling.3 For information related to caregiving, or to be connected with a local VA Caregiver Support Program team, call the VA Caregiver Support Line at 1-855-260-3274.13

Pathway 4: VA Veteran-Directed Care (VDC)

VA Veteran-Directed Care gives veterans a flexible budget for home and community services that the veteran or the family caregiver can manage. Veterans can hire their own personal care aides, which VA says might include their own family member or neighbor.7

VA says VDC is only available in certain locations, and all enrolled veterans are eligible if they meet the clinical need for the service and it is available. A copay may apply based on service-connected disability status. Ask the veteran's VA social worker whether VDC is offered where the veteran lives.7

Pathway 5: VA Aid and Attendance

VA Aid and Attendance adds monthly payments to a VA pension for qualified veterans and survivors who meet at least one of VA's listed needs, such as needing another person's help with bathing, feeding, and dressing. It requires that the veteran or survivor already qualify for a VA pension.4,3

2026 Aid and Attendance maximum annual pension rates (effective December 1, 2025 through November 30, 2026) are ceilings, not guaranteed payments. VA pays the difference between a claimant's income for VA purposes and the maximum, so someone with income receives less than the full amount:4

• Veteran with no dependents: up to $29,093 per year4
• Veteran with one dependent: up to $34,488 per year4
• Surviving spouse (no dependents): up to $18,697 per year4

Pension is paid monthly: under 38 CFR 3.273 and 3.29, the monthly rate is the maximum annual rate minus countable income, divided by 12 and rounded down to the whole dollar. Unreimbursed medical expenses may lower income for VA purposes, but VA says you may deduct only the amount above 5% of your MAPR amount, and it gives that 5% figure as $872 for a veteran with no spouse or child and $1,141 for a veteran with one dependent.4

The net worth limit is $163,699, and the primary residence, car, and basic home items are not counted as assets. VA pension also applies a 36-month look-back and penalty period to asset transfers under 38 CFR 3.276, and the look-back does not reach any date before October 18, 2018.4

Pathway 6: Private Family Arrangement

For families outside both VA and Montana Medicaid, a relative can be paid privately. If the person receiving care may apply for Montana Medicaid later, remember that Medicaid looks at resource transfers up to 60 months before the application date.8 Talk with a Montana elder-law attorney about how to document a care arrangement before any money changes hands.

How to Choose

Veteran household: If the veteran has a 70% or higher rating and needs ongoing personal care, start with PCAFC, and check all of the 38 CFR 71.20(a) conditions, not only the rating. Ask the veteran's VA social worker about Veteran-Directed Care, and look at Aid and Attendance if the veteran qualifies for a VA pension.3,7

Non-veteran Medicaid household: Confirm Medicaid eligibility, then look at Self-Direct CFCS/PCS, which can pay an adult child or other relative and, under CFCS only, a spouse generally for extraordinary care, and ask about the Big Sky Waiver if a nursing facility level of care applies.2,1

Private-pay household: A private arrangement works for families outside both systems. Involve a Montana elder-law attorney if the care recipient might apply for Montana Medicaid within the next five years, since Montana applies a 60-month look-back.8

IRS Notice 2014-7 and Taxes

IRS Notice 2014-7 lets a caregiver exclude qualified Medicaid waiver payments from federal gross income as difficulty-of-care payments. It covers payments to individual care providers under a section 1915(c) home and community-based services waiver, and only for care in the caregiver's own home, where the care recipient lives under their plan of care. It does not apply when the caregiver has a separate home where they live.14 Montana's Big Sky Waiver operates under Section 1915(c) of the Social Security Act.9

Montana's Community First Choice Services are a 1915(k) state plan benefit, not a 1915(c) waiver.1 The IRS does not treat the exclusion as automatic for a program that is not a 1915(c) waiver; it says the answer depends on the nature of the payments and the program's purpose and design. Confirm the treatment of CFCS or PCS payments with a tax professional.14

VA treats the PCAFC monthly stipend as a non-taxable benefit.6

Common Misconceptions

"CFCS/PCS lets any family member be the paid attendant on the same terms." DPHHS says adult children and other relatives may be eligible, but a spouse is treated differently: PCS alone cannot pay a spouse, and CFCS can only when the LRI rules are met, starting with care beyond what a spouse normally provides.2

"Medicare pays for ongoing personal care." Federal regulation excludes custodial care from Medicare coverage, except as necessary for the palliation or management of a terminal illness under Medicare's hospice rules.15

"A 70% VA rating means PCAFC will pay." The rating is one of VA's four first-screen conditions, and the regulation adds four more, including that the same care is not already being provided regularly by another person or entity.3

Where to Get Help in Montana

Learn More

Find personalized help choosing the right Montana paid-caregiver pathway 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.