How Medicaid Can Help Pay for Long-Term Care in Montana

Q: What is the real income limit for Montana's Big Sky Waiver?

$994/month — the standard SSI Federal Benefit Rate, not the $2,982 figure (300% of the FBR) that many general Medicaid guides incorrectly apply to every state's HCBS waiver.

Q: Does Montana require a Miller Trust for income above the limit?

No — Montana uses a spend-down approach instead. Documented medical expenses reduce your countable income down to Montana's medically needy income limit of $525/month, rather than requiring a Qualified Income Trust.

Q: Can I hire my spouse as my caregiver through the Big Sky Waiver?

Yes — the Big Sky Waiver allows participants to choose their own caregivers, including a spouse or adult child.

Published August 28, 2026 How we keep this accurate

This page is Montana-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

The number many guides get wrong

Montana's Big Sky Waiver income limit is $994/month — not $2,982. Most states use 300% of the SSI Federal Benefit Rate ($2,982/month) for their HCBS waiver. Montana doesn't — both the Big Sky Waiver and regular ABD Medicaid use the standard FBR itself ($994/month), a meaningfully lower threshold that general Medicaid guides frequently get wrong by applying the more common national figure.

The Big Sky Waiver

Montana's primary HCBS program is the Big Sky Waiver (BSW), for seniors and physically disabled adults who require a Nursing Facility Level of Care but choose to remain at home, in assisted living, or in an adult foster care home. Services include private duty nursing, home modifications, specialized medical equipment, and adult day health care.

You can choose your own caregiver — the Big Sky Waiver allows participants to select the caregiver of their choosing, including a spouse or adult child, rather than being assigned one.

No spend-down alternative required if income is over the limit

Unlike income-cap states that require a Qualified Income Trust, Montana uses a genuine spend-down approach: documented medical expenses reduce your countable income down to Montana's medically needy income limit of $525/month, rather than requiring a formal trust structure.

Two alternatives that don't require NFLOC

Community First Choice Services (CFCS) and Personal Care Services (PCS) both provide in-home assistance with daily living activities without requiring the full Nursing Facility Level of Care determination the Big Sky Waiver needs — worth asking about if you don't yet meet that higher threshold.

The 2026 financial numbers

	Big Sky Waiver / ABD Medicaid	Nursing Home Medicaid
2026 income limit	$994/month	No firm cap — patient liability applies
2026 asset limit	$2,000 (single)	$2,000 (single)
Personal Needs Allowance	Higher allowance for those living at home	$50/month

Source: Montana Department of Public Health and Human Services (DPHHS); figures effective 2026.

Spousal protections

Community Spouse Resource Allowance: up to $162,660, with a floor of $32,532.

Spousal income allowance: up to $4,067/month, depending on the community spouse's shelter and utility costs.

How to actually start

Contact Mountain-Pacific Quality Health at 1-800-219-7035 to begin a Big Sky Waiver functional assessment and financial eligibility review.

If you don't yet meet the NFLOC standard, ask specifically about CFCS or PCS as lower-bar alternatives.

Common Questions

What is the real income limit for Montana's Big Sky Waiver?

$994/month — not the $2,982 figure many general guides incorrectly apply.

Does Montana require a Miller Trust for income above the limit?

No — Montana uses spend-down, reducing countable income to a $525/month medically needy limit instead.

Can I hire my spouse as my caregiver through the Big Sky Waiver?

Yes — participants can choose a spouse or adult child as their caregiver.