If you are caring for an aging parent, a spouse, or an adult child with a disability in Montana, the state can pay a family caregiver, and possibly a spouse, through Community First Choice.

Knowing that help exists is rarely the hard part. Knowing what it is and where to start is. This guide maps every major Montana caregiver program for 2026, from paid-caregiver pathways to free respite grants and VA benefits.

You don't have to figure this out alone, and you don't have to fund all of it from your savings.

In This Guide

Montana Caregiver Programs at a Glance

Program What It Offers Pay a spouse? Cost to You
Community First Choice and the HASP waiver Pays a family caregiver to provide in-home personal care Family yes; spouse: confirm with Montana Medicaid Free (paid by Medicaid)
NFCSP respite grants Free in-home respite, adult day vouchers, training, counseling N/A Free
VA PCAFC Monthly tax-free stipend; pays spouses Yes Free (VA benefit)
VA Aid and Attendance Pension up to $2,424/mo to veteran; caregiver paid from it Pension to veteran Free to apply (VSO help)

Who Pays Family Caregivers in Montana?

If you are already doing the hands-on work of bathing, dressing, or supervising a loved one, Montana Medicaid may be able to pay you for it. In-home care runs through the Montana Department of Public Health and Human Services Senior and Long Term Care Division (SLTC), which administers two consumer-directed pathways that can put a family member on the payroll.

  • Community First Choice (CFC) is a 1915(k) Medicaid state plan option. Because it is a state plan entitlement rather than a capped waiver, everyone who qualifies is served, so there is no waiting list. CFC provides personal attendant care with consumer-direction.
  • The Habilitation and Support (HASP) waiver is a home and community-based services waiver that also allows consumer-directed personal care for eligible adults. Because waivers are capacity-limited, a HASP slot can carry a waitlist, but it can layer on supports beyond personal care.

Under the consumer-directed option, you choose and manage your own attendant, and that attendant can be a family member. Whether a spouse specifically can be hired depends on the program rules, which you confirm with Montana Medicaid at 1-800-362-8312. Consumer-direction is what turns "the family already provides the care" into "the family caregiver gets paid for it."

Eligibility rests on two tests: a functional need for help with daily activities, determined by an SLTC assessment, and financial eligibility for Montana Medicaid. Long-term care Medicaid applies a 60-month look-back on asset transfers, so gifts or transfers in the five years before applying can trigger a penalty. See the Montana Medicaid eligibility and income limits guide for the current thresholds.

For the full walkthrough of who can be paid and how the paychecks work, see How to Get Paid as a Family Caregiver in Montana.

How to Start Paid Caregiver Support

Getting paid feels bureaucratic from the outside, but it comes down to four steps, and the first phone call is free.

1
Step 1

Call Senior and Long Term Care

Reach Montana's statewide SLTC line at 1-800-332-2272 to request a screening for home and community-based services. This is the front door for Community First Choice and the HASP waiver, and there is no cost or obligation to ask.

2
Step 2

Complete the eligibility determination

SLTC assesses the functional need (help with activities of daily living) while Medicaid confirms financial eligibility. Long-term care Medicaid applies a 60-month look-back on asset transfers, so gather five years of financial records before you apply.

3
Step 3

Choose your program and consumer-directed option

With help from SLTC, pick the pathway that fits (CFC's state plan entitlement or the HASP waiver) and elect consumer-direction so you can select your own attendant.

4
Step 4

Hire your caregiver

Under consumer-direction, the person receiving care hires the attendant, who can be an adult family member. Confirm spouse-specific rules with Montana Medicaid at 1-800-362-8312 before you finalize the arrangement.

Respite Care Programs

Caregiving without a break is how burnout starts, and respite exists precisely because no one can be on call around the clock indefinitely. Montana funds it whether or not your loved one is on Medicaid.

The National Family Caregiver Support Program (NFCSP), funded by Title III-E of the Older Americans Act, flows through Montana's nine Area Agencies on Aging. Services include in-home respite, adult day vouchers, caregiver training, and counseling. Because NFCSP is a caregiver-support grant program separate from Medicaid, you qualify based on the caregiving relationship (caring for an adult 60 or older, or a person of any age with Alzheimer's or a related dementia) rather than on your loved one's Medicaid status. Find your regional agency through the Eldercare Locator at 1-800-677-1116, or dial 211.

Montana Medicaid programs and waivers can also authorize respite within the care plan. For the full respite guide, see Respite Care in Montana.

Where to Get Help

You do not need to know which program you qualify for before you call. A counselor will identify what is available in your area and help you start an application. These are the front doors, and every call below is free.

Montana Senior and Long Term Care (SLTC) Handles intake and assessment for Montana Medicaid home and community-based care, including Community First Choice and the HASP waiver. To confirm consumer-directed and spousal-hiring rules, ask for Montana Medicaid at 1-800-362-8312. 1-800-332-2272 dphhs.mt.gov/sltc
Eldercare Locator Connects you to your regional Area Agency on Aging for NFCSP respite grants, adult day referrals, caregiver training, and counseling. 1-800-677-1116 eldercare.acl.gov
Montana 2-1-1 The statewide social-services helpline for the broader network of local resources beyond aging and Medicaid programs. 211 www.211.org
VA Caregiver Support Line For caregivers of veterans: information on the PCAFC stipend, respite, and other VA caregiver benefits., 1-855-260-3274 www.caregiver.va.gov

VA Caregiver Benefits in Montana

If the person you care for is a veteran enrolled in VA health care, an entirely separate and often more generous set of benefits opens up, on top of anything Medicaid offers.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran. The stipend is calculated from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a level factor. It is federal tax-free and allows paid spouses. To qualify, the veteran needs a service-connected disability rating of 70 percent or higher, a need for in-person personal care services, and enrollment in VA health care.

If a PCAFC application is denied, a Veterans Service Officer can help you understand the decision and your options for review, at no cost.

VA Aid and Attendance Pension

Wartime veterans and surviving spouses who meet the functional criteria and have countable assets and income under the net-worth limit ($163,699 in 2026) may receive the Aid and Attendance pension. A single veteran with Aid and Attendance receives up to $2,424 per month ($29,093/year); a veteran with one dependent up to $2,874 per month. The pension goes to the veteran, who typically pays a family caregiver from it.

The Montana state veterans agency and county or town Veterans Service Officers help file at no cost.

VA Caregiver Support Line: 1-855-260-3274

Taxes for Montana Caregivers

Once you are being paid to provide care, the natural next question is how that income is taxed. The rules are more favorable than most families expect.

IRS Notice 2014-7

If you live in the same home as the person you care for and are paid through a Medicaid program, your wages may be excluded from federal gross income under IRS Notice 2014-7. This applies to many Montana self-directed caregiving arrangements. Talk to a tax preparer familiar with the rule before filing.

Montana State Income Tax

Unlike a handful of no-income-tax states, Montana levies a state income tax, and how it treats Medicaid waiver payments can differ from the federal exclusion above. Confirm your situation with the Montana Department of Revenue or a tax preparer before filing.

VA PCAFC Stipend

The PCAFC monthly stipend is federal tax-free and is not reported on a W-2.

Not sure which Montana caregiver program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's Medicaid enrollment, veteran status, and whether you are a spouse or non-spouse caregiver.

Frequently Asked Questions

Can I get paid to care for my spouse in Montana?

Possibly. Under Montana's consumer-directed Medicaid options such as Community First Choice, an adult family member can be hired as the paid attendant. Whether a spouse specifically qualifies depends on the program, so confirm the rule with Montana Medicaid at 1-800-362-8312.

Do I have to qualify for Medicaid to be paid as a caregiver in Montana?

The person receiving care does. Paid-caregiver pathways run through Montana Medicaid, so your loved one must meet both a functional need for daily-living help and Medicaid financial eligibility. Long-term care Medicaid applies a 60-month look-back on asset transfers. See the Montana Medicaid eligibility and income limits guide for current thresholds.

What happens after I apply for paid caregiver support?

Senior and Long Term Care schedules a functional assessment while Medicaid reviews your loved one's finances. Community First Choice is a state plan entitlement, so qualifying applicants are served without a waitlist; the HASP waiver is capacity-limited and can carry one. Ask SLTC at 1-800-332-2272 what to expect for your pathway.

Is there free respite in Montana without Medicaid?

Yes. The National Family Caregiver Support Program provides respite through Montana's nine Area Agencies on Aging, and it is separate from Medicaid. You qualify based on the caregiving relationship (caring for someone 60 or older, or a person of any age with dementia), not on Medicaid enrollment. Find your agency through the Eldercare Locator at 1-800-677-1116 or dial 211.

Which VA programs pay family caregivers in Montana?

The PCAFC stipend (for veterans with a 70%+ service-connected disability rating, tax-free, pays spouses) and the Aid and Attendance pension (for wartime veterans and surviving spouses under the net-worth limit). Call the VA Caregiver Support Line at 1-855-260-3274.,,

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverHow to Get Paid as a Family Caregiver in MontanaMontana's Community First Choice program and VA benefits are the main routes to paid family caregiving. Confirm family-hire rules with MT Medicaid. CaregiverRespite Care in MontanaMontana funds respite care via Medicaid consumer-directed care that may pay a spouse, free NFCSP grants with no income test, and the VA for veterans. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. VA BenefitsVA Benefits for Seniors in MontanaVA Aid and Attendance in Montana for 2026: who qualifies, monthly rates up to $2,874, how to apply, and free help from accredited Veteran Service Officers. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.

Find personalized help navigating Montana caregiver programs 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.

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Brevy Care Team

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