Page Reviewed / Updated – July 07, 2014

Waiver Description

Big Sky Bonanza is Montana’s consumer directed Medicaid waiver program for adults, sometimes referred to as BSB or Independence Plus.  In summary, this program provides the care recipient with a monetary budget and allows them to manage all aspects of their care.  It provides great flexibility and comes with great responsibility as participants take on the medical liability associated with their care.  

Consumer direction of care, sometimes referred to as Cash and Counseling, works as follows.  Once accepted into the Big Sky Bonanza Program, Montana’s Senior and Long Term Care Division (SLTCD) assesses the participant’s care needs and works with them to develop a Support Service and Spending Plan (SSSP).  This plan outlines care needs and provide a monetary budget for care services.   The participant is then responsible for filing in all the details of the plan.  They choose what type of care, how much care, from whom to receive care and how much to pay.  Individuals who are not fully capable of managing these processes can have a family member, such as an adult child serve as their “Personal Representative”. 

Under Big Sky Bonanza, family members can receive compensation for their caregiving services.

Big Sky Bonanza, and consumer directed programs in general, are popular with families for a variety of reasons, but largely because family members can be hired as paid caregivers.   Adult children and friends receive payment for the caregiving services many are already providing free of charge.  This is a great financial relief as in many families persons give up working in order to care for a loved one.  To be clear, while the program participant chooses how much to pay their caregivers, they are permitted a range of hourly rates which most certainly cannot exceed the average hourly rate for home care in Montana ($20 / hr.).   Also, to avoid conflicts of interest one’s “Personal Representative” cannot also be a paid caregiver. 

Eligibility Guidelines

To participate in this program, candidates must meet several different eligibility requirements.  

  • Be legal Montana residents
  • Be at least 21 years of age
  • Must require “nursing home level care” as determined by a physician.
  • Have countable assets (which exclude the value of a home) of less than $2,000.
  • Have monthly income less than $733 in 2015.  This persons are referred to as being categorically needy.  Persons with higher incomes may still qualify as being medically needy.  Medically needy participants are required to spend any income in excess of the limit on their care services.

Benefits and Services

Individuals participating in this program are free to direct their allocated budget as they best see fit.  Having said that, there is a suite of services and supports which are approved and those which require special exception.  For the most part, the following services are covered.  

  • Adult Day Health
  • Adult Residential Living
  • Disposable Medical Supplies
  • Environmental Adaptations (Minor home modifications)
  • Home Medical Equipment
  • Homemaker Services
  • Occupational Therapy
  • PERS (Personal Emergency Response Services)
  • Personal Assistance
  • Physical Therapy
  • Private Duty Nursing
  • Respite Care
  • Transportation


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How to Apply / Learn More

As this is a Medicaid program, one should contact their local Medicaid office for more information and to apply for the program.  Candidates should be aware that this program has a limited number of slots available and waiting lists may exist.