Montana Medicaid Home and Community Based Services Waiver (Big Sky Waiver)

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

This Montana Medicaid program allows individuals that require nursing home level care to receive that care in their home or community in place of in a nursing home.  A wide variety care services and non-care support is provided both to the program participant and to their primary caregiver to allow them to live at home or in an assisted living residence.  Even minor home modifications which can decrease the beneficiary's reliance on other persons are considered an allowable expense. 

This waiver is also referred to as the Elderly/Physically Disabled Waiver and Big Sky Home and Community Based Services. 

Under this waiver, Montana residents have the option of self-direction or consumer direction. Meaning, participants have the right to choose their care providers. However, care providers are subjected to approval by the state. Interestingly, certain family members are eligible to be hired as personal care attendants. Typically, spouses are excluded from this option but under certain circumstances spouses can be paid providers.  More commonly, the adult children who are caring for aging parents are paid as caregivers. Care providers must be qualified to provide care therefore the types of care family members can be paid to provide is usually limited to personal care or homemaker services.

This waiver is also referred to as the Elderly/Physically Disabled Waiver and Big Sky Home and Community Based Services.  In 2016, the state extended the waiver expiration for 5 years until 2021.

 Did You Know?
2 out of 3 individuals will become physically or cognitively impaired at some point in their life and 1 out of 3 will enter a nursing home.  HCBS Waivers are designed to reduce that rate.

 

Eligibility Guidelines

The following guidelines are current for the year 2017. Montana Medicaid allows for multiple pathways into the program. One can be categorically needy or medically needy. These two pathways differ only in the income limits. This is explained in detail below.

Age - there are no specific age requirements, however the type of services available may depend on the applicant's age.

Level of Impairment - applicants are given a medical review. Those found to require the level of care provided in a nursing home are eligible.

Financial Assets – unmarried (or widowed) applicants must have under $2,000 in countable assets. Married applicants are allowed a higher level of assets to prevent a healthy spouse from becoming impoverished (this assumes the spouse is healthy and not applying for Medicaid as well). This higher resource limited is referred to the Community Spouse Resource Allowance and in 2017, the limit is set at $120,900. Jointly held assets up to this amount can be allocated to the healthy spouse.

Note these limits are for Countable Assets; there are also assets that Medicaid does not count towards this limit. Most notably, the home. The homeowner’s equity value in their home is not counted provided a) the equity value is less than $560,000 and b) the homeowner remains living in the home. Therefore, single applicants who reside in assisted living, not at home, will have their homes counted toward the asset limit. While married applicants, if one or both spouses remain in the home, will not have the home’s value counted towards the limit. Other non-countable assets include items furnishing the home, personal items and a vehicle.

Categorically Needy Income Limit - Categorically Needy recipients have monthly income less than 100% of the Federal Benefits Rate, which in 2017 for a single applicant is set at $735 / month. Married couples with a single applicant will have their incomes considered separately. The non-applicant spouse can have up to $3,022 / month in income which otherwise would be considered the applicant’s spouse income.

Medically Needy Income Limits - Medically Needy recipients have recurring, required medical costs equal to or near their monthly income levels so that they have inadequate resources remaining to cover standard living expenses. For example, a person with $5,000 in monthly income, but $4,800 per month in recurring care expenses will very likely qualify as Medically Needy even though they are well over the aforementioned income limit. A ballpark estimate is persons who have less than $500 difference between their monthly income and care expenses will qualify.

 Families Over the Limits
Families who exceed these limits may still qualify for Medicaid by employing a Medicaid planning professional. Read more about this option.  

 

Benefits and Services

All beneficiaries are eligible to receive case management services. Other services are determined case by case and can include the following. Not every applicant is eligible for every service.

  • Adult Residential Living / Assisted Living (but only care costs, not room and board)
  • Adult Day Health Care
  • Habilitation Services
  • Homemaker Services
  • Home Modifications (to improve access and safety)
  • Personal Assistance
  • Personal Emergency Response Service (also called Medical Alert services)
  • Private Duty Nursing
  • Psychosocial Counseling
  • Respite Care for the Caregiver
  • Transportation Assistance and Coordination

 

How to Apply / Learn More

Residents throughout Montana are eligible for assistance, regardless of county.  HCBS Waivers have enrollment caps and waiting lists frequently exist.  One can learn more or apply by visiting the state website or calling 800-219-7035.