Montana Community First Choice / Personal Assistance Programs (CFC / PAS)

Program Description

Under the CFC / PAS Program, certain family members can be hired as paid caregivers.

Montana Community First Choice / Personal Assistance Programs (CFC / PAS) is a Medicaid program designed for elderly or disabled residents that require in-home care service.  Individuals can receive care services from the state or they can elect to hire and train their own care providers who are then paid by the Provider Agency. This type of self-directed care program is also referred to as cash and counseling, consumer direction or participant direction.

In past years, this program was referred to as Self-Directed Personal Assistance Services (SDPAS). 

One element of CFC / PAS that is attractive to many families is that certain family members can be hired to provide personal care; they can be paid caregivers. Although spouses, parents and legal guardians are not eligible, the adult children of aging parents and ex-wives or ex-husbands can be paid to provide personal care services. To be clear, the Montana Medicaid Provider Agency is not obligated to hire family members, however given family members' emotional commitment to the individual in need of care, typically they make good caregivers and the state will hire them.

During initiation and periodically during active enrollment, a health care professional will assess the individual in need of care and determine the types and amount of in-home care they require. The plan of care is developed or modified and the hired caregiver (their Personal Assistant), must follow this plan of care.  The individual self-directing their care is responsible for approving their Personal Assistant's timesheets. The Provider Agency (the state) is responsible for reviewing the timesheets and making payments to the Personal Assistant.


Eligibility Guidelines

CFC / PAS is a Medicaid program. In addition to being financially eligible to receive Medicaid, individuals must have a medical condition that creates a need for in-home assistance.

To participate in the self-directed portion of the program, participants must be capable of directing their own care, or have a Personal Representative (other than their Personal Assistant) who can direct the care on their behalf.

Montana Medicaid Income Limits - for 2017, single applicants have an income limit of 100% of the Federal Benefits Rate / Supplemental Security Income which is equal to $735 / month. Alternatively, Montana also offers a Medically Needy option for persons whose incomes are higher than the limit provided they have high, monthly, medical expenses that consume the majority of their incomes. Married Medicaid applicants over this limit can also become eligible by allocating joint income to their spouses provided the spouses are not also seeking Medicaid help. This is called the spouse's Minimum Monthly Maintenance Needs Allowance or MMMNA. Under certain circumstances, joint income up to $3,022.50 / month can be allocated.

Montana Medicaid Asset Limits - for 2017, single applicants are permitted up to $2,000 in countable assets. Married applicants with non-applicant spouses can portion off up to $120,900 in resources to their spouse to enable them to live independently. This is called the Community Spouse Resource Allowance. When calculating assets, certain resources are not counted. Most relevantly, these include the home provided it is owner-occupied and valued under $560,000, utility vehicle and some personal effects. Assets transferred from the applicant's ownership for 5 years previous to application are evaluated to make certain they were not transferred under market value or given away to lower one's countable resources in order to qualify. This is referred to as Medicaid's Lookback Penalty.

Even though one may not be financially eligible for Medicaid, it is not uncommon to not be able to afford the cost of care. Fortunately, there are Medicaid planning professionals that help applicants to qualify through the use of exempt trusts, annuities and other financial tactics. It is strongly advised that families and individuals in these circumstances find assistance qualifying for Medicaid in Montana. Learn more.


Benefits and Services

The types of services that can be provided in CFC / PAS include assistance with all the activities of daily living such as bathing, dressing, toileting and basic mobility in and around the home.  Assistance is also available for the Instrumental Activities of Daily Living such as meal preparation, light housekeeping and laundry.  Home maintenance and yardwork are covered should they be a safety hazard.  Personal emergency response services (PERS) such as Medical Alert, Guardian and Life Alert can also be benefits of the program.


How to Apply / Learn More

This program is managed by the Montana Department of Public Health and Human Services, Division of Senior and Long Term Care. Within the state, there are field offices for public assistance. Contact information for the field offices is available here.

More information about the program is also available on the Public Health and Human Services website .