Montana Medicaid pays for care in your own home and community, not only in a nursing home, and it does so mainly through one program: the Big Sky Waiver (BSW). Montana Medicaid home- and community-based services (HCBS) waivers like the Big Sky Waiver exist for one reason, which is to let a person who would otherwise need a nursing facility stay in their own home instead.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 To use the Big Sky Waiver, a person has to qualify for Medicaid financially and meet the level of care Montana would require for a nursing-facility placement.
In This Guide
- What Are Montana Medicaid HCBS Waivers?
- Inside the Big Sky Waiver, Montana's HCBS Program
- Who Qualifies for Montana Medicaid HCBS Waivers?
- What the Big Sky Waiver Covers
- The Big Sky Waiver Waiting List and How Enrollment Works
- How to Apply for the Big Sky Waiver
What Are Montana Medicaid HCBS Waivers?
Home- and community-based services, usually shortened to HCBS, is the part of Medicaid that pays for long-term care delivered outside an institution, in your own home, a family member's home, or another community setting rather than a nursing facility. States deliver these services under a federal authority called a Section 1915(c) waiver, which lets a state "waive" the usual rule that Medicaid long-term care happens in an institution and instead fund care in the community.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371
The idea is straightforward once you see it. Nursing-home care and home care serve the same person with the same level of medical need, but one keeps that person at home. A 1915(c) waiver is the mechanism that lets Medicaid pay for the home option.
Montana runs its main HCBS program for older adults and people with physical disabilities through a single 1915(c) waiver, the Big Sky Waiver. So when families search for Montana Medicaid HCBS waivers, the Big Sky Waiver is almost always the program they are looking for.
Inside the Big Sky Waiver, Montana's HCBS Program
The Big Sky Waiver (BSW) is administered by the Senior and Long-Term Care Division of the Montana Department of Public Health and Human Services (DPHHS). Its purpose is direct: it allows people who would otherwise be institutionalized to live in their own home and community instead.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371
Once someone is enrolled, their care is not left to chance. Each participant works with a Case Management Team made up of a nurse and a social worker, who assess needs, build the plan of services, and coordinate the supports that keep the person safely at home.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 That pairing matters, because home-based long-term care usually involves both a medical side and a daily-living side, and the two-person team is set up to cover both.
The waiver's current federal authority (waiver number 0148.R07.00) was approved by the federal Centers for Medicare & Medicaid Services on June 20, 2024, effective July 1, 2024 through June 30, 2029.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 That approval period is worth knowing only because it tells you the program is active and federally authorized through the end of the decade.
Who Qualifies for Montana Medicaid HCBS Waivers?
Eligibility for the Big Sky Waiver comes down to two tests that a person has to meet at the same time.
The first is functional, meaning it is about your care needs. To qualify, you must meet the minimum level of care required for a nursing-facility placement.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 In plain terms, your needs have to be serious enough that, without help, a nursing facility would be on the table. On top of that, Montana looks for an unmet need that only the Big Sky Waiver's services can resolve, so the waiver is filling a real gap rather than duplicating care you already have.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371
The second test is financial. A person must be financially eligible for Medicaid to enroll in the waiver.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 Montana's long-term care Medicaid income and asset rules are their own detailed subject, and you can work through them in our guide to Montana Medicaid income and asset limits. The key point here is that meeting the care level alone is not enough; the financial side has to line up too, and the county office that handles Medicaid eligibility is the one that makes that determination.
What the Big Sky Waiver Covers
The Big Sky Waiver funds a range of home- and community-based supports, not a single service. The exact plan is built around what a participant actually needs, but the services the waiver may include are:Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371
- Personal assistance with everyday activities
- Homemaker services
- Adult day health
- Respite care, which gives a family caregiver a break
- Environmental adaptations, meaning home modifications such as ramps or grab bars
- A personal emergency response system (PERS), the button or device that summons help in an emergency
- Private duty nursing
- Transportation
Two things are worth underlining. First, this is a "may include" list, so which services a given person receives depends on their assessment and plan, not on the menu being handed out in full.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 Second, several of these supports exist as much for the family as for the participant. Respite care in particular is built to relieve an unpaid family caregiver, which is often the difference between a home arrangement lasting and falling apart.
If the level of care eventually points toward a facility instead, our guide to Montana Medicaid and nursing home care covers that side of long-term care.
The Big Sky Waiver Waiting List and How Enrollment Works
The Big Sky Waiver currently operates a waiting list, and that is the fact families most need to plan around.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 A 1915(c) waiver is allowed to cap how many people it serves, which is different from regular Medicaid coverage that everyone eligible receives as a matter of right. So even when you meet both the care-level test and the financial test, an open slot may not be available the day you apply, and you may spend time on the list before enrollment.
That reality shapes the smart move, which is to start early. Getting your referral in and your Medicaid financial eligibility established puts you in the process rather than at the beginning of it, so that when a slot opens you are ready rather than starting from scratch. Waiting to apply until the need is urgent is the most common way families lose months they did not have to lose.
How to Apply for the Big Sky Waiver
Applying for the Big Sky Waiver runs on two tracks that move in parallel, and it helps to picture them side by side.
Track one: the waiver referral. To get into the Big Sky Waiver itself, a person makes a referral to the state's contractor, Mountain-Pacific Quality Health, at (800) 219-7035 or (406) 443-4020.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 That referral starts the level-of-care assessment and gets you into the waiver's process, including the waiting list.
Track two: Medicaid financial eligibility. Because you must be financially eligible for Medicaid to use the waiver, your Montana Medicaid eligibility is determined by your county Office of Public Assistance.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 Federal rules require the state to let you apply for Medicaid through more than one door, including online, by phone, by mail, or in person at a local office.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Our step-by-step guide to applying for Montana Medicaid walks through that side in full.
On the financial application, the state also works under a clock. Federal Medicaid regulations give the agency a maximum of 45 calendar days to decide most applications, and up to 90 calendar days when eligibility is based on a disability.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf Those are ceilings, not the typical wait, but they tell you the outer edge of how long the financial determination should take.
The Senior and Long-Term Care Division of DPHHS is the state agency behind the waiver, and its Big Sky Waiver page is the place to confirm current contact details before you call.
Frequently Asked Questions
Does the Big Sky Waiver have a waiting list right now?
Yes. The Big Sky Waiver (BSW) currently operates a waiting list.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 Because a Section 1915(c) home- and community-based services (HCBS) waiver can limit how many people it serves at once, meeting the eligibility tests does not guarantee an immediately open slot. That is the main reason to make your referral and establish Medicaid eligibility early, so you are already in the process when a spot opens.
Can the Big Sky Waiver keep me out of a nursing home?
That is exactly what it is designed to do. The waiver allows people who would otherwise be institutionalized to live in their own home and community instead, funding supports like personal assistance, homemaker services, and private duty nursing so the care can happen at home.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 You still have to meet the nursing-facility level of care and qualify for Medicaid financially, but the whole point of the program is to make the home option possible.
Who runs the Big Sky Waiver, and how is my care coordinated?
The waiver is administered by the Senior and Long-Term Care Division of the Montana Department of Public Health and Human Services (DPHHS).Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 Once you are enrolled, a Case Management Team made up of a nurse and a social worker assesses your needs, builds your service plan, and coordinates your supports, so both the medical and the daily-living sides of your care have someone responsible for them.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371
How do I actually start the application?
Two steps at once. Make a referral to the state's contractor, Mountain-Pacific Quality Health, at (800) 219-7035 or (406) 443-4020 to begin the waiver process, and have your Medicaid financial eligibility determined through your county Office of Public Assistance.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - MT Big Sky Waiver (BSW) (0148.R07.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82371 You can file the Medicaid application online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Running both tracks together is what keeps the timeline from stretching out.
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