Page Reviewed / Updated - Feb. 2019
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 (agency based) 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 that is required. The plan of care is developed or modified and the hired caregiver (one’s Personal Assistant) must follow this plan of care. The individual self-directing his/her care is responsible for approving his/her Personal Assistant's timesheets. The Provider Agency (the state) is responsible for reviewing the timesheets and making payments to the Personal Assistant.
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 due to the inability to complete daily living activities on their own.
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 2018, single applicants have an income limit of 100% of the Federal Benefit Rate / Supplemental Security Income, which is equal to $771 / month. Married couples, with both spouses as applicants, can have income up to $1,157 / month. Alternatively, Montana also offers a Medically Needy option for persons whose income is higher than the limits provided above, given they have high, monthly, medical expenses that consume the majority of their incomes. Married Medicaid applicants over the above income limit can also become eligible by allocating some of their income to their spouses, provided the spouses are not also seeking Medicaid help. Under certain circumstances, income up to $3,161 / month can be allocated to the non-applicant spouse (also called a community spouse or well spouse).
This is called the Monthly Maintenance Needs Allowance or MMNA and is intended to prevent the community spouse from becoming impoverished.
Montana Medicaid Asset Limits - for 2019, single applicants are permitted up to $2,000 in countable assets, and married couples with both spouses applying for services can have up to $3,000 in assets. Married applicants with non-applicant spouses can portion off up to $126,420 in resources to their spouse to enable them to live independently. This is called the Community Spouse Resource Allowance. Make note, the applicant spouse is still able to retain up to $2,000 in assets. When calculating assets, certain resources are not counted. Most relevantly, these include the primary home, provided it is owner-occupied and valued at or under $585,000, a 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 Look-Back Period. Violating this period can unfortunately result in a period of Medicaid ineligibility.
Even though one may not be financially eligible for Medicaid, it is common for one to still unable to afford his/her cost of care. Fortunately, there are Medicaid planning professionals that help applicants to qualify through the use of exempt funeral trusts, Medicaid compliant 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.
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, medication assistance, 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, grocery shopping, and laundry. Home maintenance and yard work are covered should there be a safety hazard if not done. Personal Emergency Response Services (PERS), such as Medical Alert, Guardian, and Life Alert can also be benefits of the program.
This program is managed by the Montana Department of Public Health and Human Services (DPHHS), 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 this program is also available on the Public Health and Human Services website.