Montana's caregiver programs can pay a family member for in-home care through Medicaid's Community First Choice Services and Personal Care Services (CFCS/PCS) and the Big Sky Waiver. If you are caring for an aging parent, a spouse, or an adult child with a disability, adult children and other relatives may be eligible to be paid, while a spouse can be paid in most cases only for extraordinary care under CFCS or the Big Sky Waiver (not under PCS alone), generally up to 40 hours a week.,

This guide maps Montana's main caregiver programs for 2026, from paid-caregiver pathways to respite support 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
Medicaid CFCS/PCS and the Big Sky Waiver Pays a family caregiver to provide in-home personal care In most cases only for extraordinary care, up to 40 hours a week; not under PCS alone Paid by Medicaid
NFCSP respite Respite at home or in adult day care, training, counseling N/A Ask your Area Agency on Aging; any cost share must be income-based
VA PCAFC Monthly stipend (nontaxable, per VA's 2020 proposed rule) if the veteran is rated 70%+ and meets VA's other conditions Yes VA benefit
VA Aid and Attendance Added to a VA pension for a veteran who needs help with daily activities or meets another VA need condition; up to a $29,093/yr maximum annual rate (no dependents) Pension to veteran Free claim help from accredited Montana VSOs

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. These in-home programs are run by the Montana Department of Public Health and Human Services Senior and Long Term Care Division and administered by its Community Services Bureau. Two Medicaid pathways can put a family member on the payroll.,,

Both programs offer an agency-based option and a self-directed option. Under Self-Direct CFCS/PCS, the member or their personal representative chooses, hires, trains, and manages the personal care attendants, while the provider agency processes payroll, withholds taxes, and runs the required pre-employment checks.,,

Who Can Be Paid

Program Adult child or other relative Spouse
CFCS (nursing home level of care) May be eligible to be paid as a personal care attendant In most cases only for extraordinary care, generally up to 40 hours a week
PCS (no nursing home level of care) May be eligible to be paid as a personal care attendant No; ask for a re-screening to move into CFCS
Big Sky Waiver Some in-home care can come from a relative Only for care beyond usual spousal duties, up to 40 hours in 7 days

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, and its November 2025 member newsletter says Big Sky Waiver members can get some types of in-home care from a relative.,

A spouse faces stricter rules, because Montana treats a spouse as a legally responsible individual (LRI). Under CFCS, the care must exceed what is normally expected of a spouse, shown by a state-approved functional assessment, and 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. A spouse cannot be the paid caregiver and the personal representative at the same time, and LRI care cannot cover general household tasks that benefit the whole family. Montana's rule also allows an LRI to be paid for care that is not extraordinary when no other provider is available because of geographic, cultural, or other factors. Under PCS alone, a spouse cannot be paid; 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 for CFCS.

Under the Big Sky Waiver, the spouse's care must go beyond what the family would ordinarily do and be necessary to avoid institutionalization, a qualified professional must find that the extra care serves the member's best interest, the spouse must be employed as a personal care worker by a provider agency or by the member through self-direction, and the choice of a spouse must be documented in the plan of care. A spouse who is also the member's representative may not be paid, and DPHHS's waiver amendment application extends that to a relative or guardian who is the member's authorized representative. For more on the spouse rules, see How to Get Paid to Care for Your Spouse in Montana.

The DPHHS materials cited here don't list a relative who lives with the member as a separate category, so ask the program about a live-in arrangement. A 2015 DPHHS self-direction policy says household tasks done as part of a shared living environment are not authorized when the member lives with family.

Montana Medicaid also applies a 60-month look-back to uncompensated transfers, so gifts in that window can affect eligibility. See the Montana Medicaid eligibility and income limits guide for the current thresholds.

For the full walkthrough of 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.

1
Step 1

Apply for Montana Medicaid if your loved one is not already enrolled

Apply online at apply.mt.gov, through the Montana Public Assistance Helpline at 1-888-706-1535, or at a local Office of Public Assistance. Montana applies a 60-month look-back to uncompensated transfers, so gather five years of financial records first.

2
Step 2

Call the right program line

For CFCS/PCS, call the DPHHS program contact at 406-444-4564. For the Big Sky Waiver, make a referral through Mountain Pacific Quality Health at 1-800-219-7035.

3
Step 3

Complete the screening and choose self-direction

Your loved one takes part in the screening process, and CFCS requires a nursing home level of care. Choose the self-directed option so your loved one, or their personal representative, can choose and hire the attendant.,

4
Step 4

Hire your family caregiver

Adult children and other relatives may be eligible to be paid. If the caregiver is a spouse, confirm the care counts as extraordinary and that the spouse is not also the personal representative; on a PCS-only plan, request a re-screening for CFCS first.

Respite Care Programs

Caregiving without a break wears anyone down, and respite is what gives you time off. NFCSP respite does not depend on your loved one being 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 information and help getting access to services, counseling, support groups and caregiver training, respite care, and limited supplemental services. 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. For respite and supplemental services, the older adult you care for must need substantial help with at least two daily activities, or substantial supervision because a cognitive or other mental impairment makes their behavior a serious health or safety hazard. Federal law lets a state charge a sliding-scale cost share for some Older Americans Act services, based only on income and the cost of the service (never on assets), but not for anyone at or below the federal poverty line, and a service cannot be denied because someone cannot pay. Find your regional agency through the Eldercare Locator at 1-800-677-1116.

For the full respite guide, including Medicaid options, 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.

Montana CFCS/PCS Program (DPHHS) The DPHHS contact for Community First Choice Services and Personal Care Services, including self-direction and who can be hired as a paid attendant. The Senior and Long Term Care Division is at (406) 444-4077. 406-444-4564 dphhs.mt.gov/sltc/csb
Big Sky Waiver Referrals (Mountain Pacific Quality Health) Takes referrals to the Big Sky Waiver. Medicaid financial eligibility is decided separately by your County Office of Public Assistance. 1-800-219-7035 dphhs.mt.gov/sltc/csb/BSW/BigSkyWaiverProgram
Montana Medicaid Application The Montana Public Assistance Helpline and online application for Montana Medicaid. You can also apply at a local Office of Public Assistance. 1-888-706-1535 apply.mt.gov
Eldercare Locator A free public service of the Administration for Community Living that connects you to your local Area Agency on Aging for NFCSP respite, caregiver training, and counseling., 1-800-677-1116 eldercare.acl.gov
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, a separate set of VA caregiver benefits may be available, each with its own eligibility rules.

PCAFC can be combined with other in-home care, subject to one limit. VA says a veteran and caregiver may take part in more than one in-home care program, as applicable. PCAFC carries one limit: the personal care services your family caregiver would provide cannot be simultaneously and regularly provided by or through another individual or entity, and VA will revoke a family caregiver's designation if the veteran stops meeting that requirement. Before another program, such as a Montana Medicaid paid-caregiver program, pays for that same personal care, ask your local VA Caregiver Support Program team how it affects PCAFC.

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 starts from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, so it is not an hourly wage. 38 CFR 71.40(c)(4)(i) then multiplies that monthly base by a factor, and there is not just one: the regulation sets five rungs across two schedules, using three distinct multipliers (0.625, 1.00 and 0.25). A spouse can be the paid caregiver., In the preamble to its 2020 proposed PCAFC rule, VA described the stipend as a nontaxable benefit.

Which schedule applies depends on whether the veteran is in the current program under 38 CFR 71.20(a), or is a legacy participant or legacy applicant under 38 CFR 71.20(b) or (c), meaning a household whose connection to PCAFC predates the program's October 1, 2020 restructuring. In the current program the factor is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community." On the legacy route the factor is set instead by the sum of the veteran's 2019 clinical ratings: 1.00 at a sum of 21 or higher, 0.625 at 13 to 20, and 0.25 at 1 to 12, with no self-sustain determination required. A legacy Montana household rated 21 or higher therefore reaches the full 1.00 on the rating sum alone, and should not treat 0.625 as its ceiling. A veteran who meets both sets of criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still resides at the address on record with PCAFC. The legacy schedule lapses October 1, 2028.,

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

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

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. VA says the veteran and caregiver apply together and go through an application process to determine eligibility. The four further requirements are:

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

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.

If a PCAFC application is denied, the Montana Veteran Affairs Division's accredited Veteran Service Officers offer no-cost help, including with the appeals process.

VA Aid and Attendance Pension

Aid and Attendance is a monthly payment VA adds to a monthly VA pension for qualified veterans and survivors. A veteran or survivor who gets a VA pension may be eligible if at least one of VA's conditions is true, such as needing another person to help with daily activities like bathing, feeding, and dressing, or being a nursing home patient due to the loss of mental or physical abilities related to a disability. The Veterans Pension requires wartime service, among other conditions. The 2026 net worth limit is $163,699, counting the claimant's and dependents' assets and income for VA purposes. VA sets the benefit as a maximum annual rate, not a flat payment: the Aid and Attendance maximum annual pension rate is $29,093 for a veteran with no dependents and $34,488 for a veteran with one dependent, and VA pays the difference between the veteran's countable income and that maximum. Countable income is not gross income: VA says non-reimbursable medical expenses above 5% of the maximum rate can reduce it. The pension is paid to the veteran.

The Montana Veteran Affairs Division's accredited Veteran Service Officers help veterans, spouses and dependents file VA pension claims at no cost, through nine offices statewide; its general line is 406-324-3742.

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 answer depends on which program pays you.

IRS Notice 2014-7

IRS Notice 2014-7 lets the IRS treat certain payments under a Medicaid 1915(c) home and community-based waiver as difficulty-of-care payments excluded from federal gross income. The exclusion applies only to payments for care in your own home, where the person you care for lives under their plan of care, and it does not apply if you have a separate home where you reside. The Big Sky Waiver is a 1915(c) waiver.

CFCS/PCS is different: it is a 1915(k) state plan benefit, not a 1915(c) waiver. The IRS says whether it treats payments under a program other than a Medicaid waiver as excludable depends on the nature of the payments and the purpose and design of the program, so a CFCS/PCS caregiver should not assume the exclusion applies. Talk to a tax preparer familiar with the rule before filing.

Montana State Income Tax

Montana has a state income tax, and Montana computes state taxable income starting from federal taxable income. Confirm how Montana treats your caregiver pay with the Montana Department of Revenue or a tax preparer before filing.

VA PCAFC Stipend

In the preamble to its March 2020 proposed PCAFC rule, VA described the monthly personal caregiver stipend as a nontaxable benefit.

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 parent in Montana?

Yes, if your parent qualifies for one of the programs. DPHHS says adult children and other relatives may be eligible to be paid as a personal care attendant under CFCS/PCS, and Big Sky Waiver members can get some types of in-home care from a relative.,

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

Only in limited cases. Under CFCS and the Big Sky Waiver, a spouse can be paid in most cases only for extraordinary care beyond what a spouse normally provides, generally up to 40 hours a week, and not while also serving as the member's representative. For CFCS, Montana's rule makes an exception for care that is not extraordinary when no other provider is available because of geographic, cultural, or other factors. A spouse cannot be paid under PCS alone; the member must first be re-screened and qualify for CFCS., For veterans, VA's PCAFC stipend can go to a spouse.

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

The person receiving care does. For CFCS/PCS, your loved one must have a health condition that limits daily activities, take part in the screening process, and be eligible for Medicaid; CFCS and the Big Sky Waiver also require a nursing facility level of care. Montana Medicaid applies a 60-month look-back to uncompensated transfers. See the Montana Medicaid eligibility and income limits guide for current thresholds.

What happens after I apply for paid caregiver support?

Your loved one takes part in a screening, and CFCS requires a nursing home level of care. For the Big Sky Waiver, Mountain Pacific Quality Health takes the referral, your County Office of Public Assistance decides financial eligibility, and DPHHS says there are currently waiting lists. Ask the CFCS/PCS line at 406-444-4564 what to expect for your pathway.

Can I get respite in Montana without Medicaid?

Yes. The National Family Caregiver Support Program provides respite through Montana's nine Area Agencies on Aging, separately from Medicaid. For respite, the older adult you care for must need substantial help with two or more daily activities, or supervision because a cognitive or mental impairment makes their behavior a serious health or safety hazard. Any cost share must be income-based. Find your agency through the Eldercare Locator at 1-800-677-1116.

Which VA programs pay family caregivers in Montana?

The PCAFC stipend (for veterans who meet all of VA's PCAFC conditions, which start with a 70%+ service-connected disability rating; VA called it nontaxable in its 2020 proposed rule; pays spouses) and Aid and Attendance (added to a VA pension; someone who gets that pension, which requires wartime service among other conditions, may be eligible if they meet one of VA's listed needs, such as help with daily activities)., 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 CFCS/PCS and Big Sky Waiver can pay family caregivers in 2026; veterans' families can add PCAFC, Veteran-Directed Care, and Aid and Attendance. CaregiverRespite Care in MontanaMontana funds respite care through the Medicaid Big Sky Waiver, NFCSP caregiver grants via Area Agencies on Aging, and the VA for enrolled veterans. 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. MedicaidHow Montana Medicaid Pays for Home Care: The Big Sky WaiverMontana 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. CaregiverAre Medicaid Waiver Payments Taxable? The Difficulty-of-Care Rule for a Paid Family CaregiverAre Medicaid waiver payments taxable? Usually not, if you live with the person you care for. What IRS Notice 2014-7 excludes, what it misses, how to report it. 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, annual rates up to $34,488, 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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