Home Care in Montana

According to the 2021 Genworth Cost of Care Survey, the average cost for home care in Montana is $5,339 per month, and prices for home health care are the same. Home health care provides medical services, such as skilled nursing, therapies and disability or illness management. Home care service assists with household upkeep but doesn’t include medical services.

Montana’s monthly home care cost of $5,339 is higher than the monthly national average of $4,957 but cheaper than its surrounding states. Idaho’s prices are slightly higher at $5,434 per month, and Wyoming’s monthly costs rise somewhat to $5,529. North Dakota seniors pay $5,689 per month. South Dakota is the region’s most expensive state, with monthly prices averaging $5,911.

Montana’s home health care costs $5,339 per month, making it the cheapest option yet again. Home health care expenses in Idaho, Wyoming, North Dakota and South Dakota are the exact price as their home care costs. Montana’s price is only a little higher than the national average of $5,148.

There are a few other kinds of care to consider depending on your needs. Nursing home care is ideal for people who require a high level of supervision and clinical services due to physical or cognitive impairment. It’s the most specialized type of care and is priced accordingly at $7,574 for a semiprivate room. Assisted living, which costs $4,450, can be an appealing option if you don’t want to maintain a household or prefer to live in a community setting. For $2,600, you can get adult day care, which provides services during normal business hours only.

In Montana, Medicaid pays for home care through two home- and community-based service options: the Big Sky Waiver and the Community First/Personal Assistance Services Program.

Big Sky Waiver

The Big Sky Waiver enables seniors to remain in their homes and communities instead of an institution through many social services and supports. Seniors can get personal care, housekeeping, transportation to doctor’s appointments and environmental adaptations to make their homes safer to navigate. The waiver also includes clinical services such as therapies, private-duty nursing, mental health consultations and specialized medical equipment and supplies. The program can only serve a limited number of people per year. If it reaches this cap, you may be placed on a waiting list to get services.

To qualify for the Big Sky Waiver, you must:

• Be financially eligible for Medicaid
• Meet the minimum level of care requirements for nursing facility placement
• Have an unmet need that the Big Sky Waiver can only meet

To make a self-referral for the Big Sky Waiver, call Mountain-Pacific Quality Health at (800) 219-7035. If accepted, you will be assigned a case management team consisting of a social worker and nurse. Your team will assess your needs and work with you to develop a comprehensive care plan.

Community First/Personal Assistance Services (CFA/PAS) Program

The CFA/PAS Program provides long-term supportive care in a home setting. The program tailors care to each senior’s specific living situation, personal needs and family caregiver availability. It covers nonclinical help with daily living activities, including grooming, dressing, bathing, toileting and eating meals. The program also assists with light housekeeping, laundry, shopping and yard hazard removal. Non-medical transportation, major cleaning, home modifications and home repairs are not covered.

CFA/PAS has two options to receive services: Self-direct and Agency-based. The Self-direct option allows you to choose your own providers and manage your own care. Under the Agency-based option, a case management team will organize and direct services on your behalf.

To be eligible, you will need to:

• Qualify for Medicaid
• Undergo a medical screening process
• Have a health condition that requires help with activities of daily living

For more information about program eligibility and membership, contact the program manager at (406) 444-4564.

To qualify for Medicaid, you must meet certain income and asset limits, such as investments, bank accounts and property you own (excluding your primary residence). In Montana, your yearly income can’t exceed $10,092 ($841/month) for a single person and $15,132 ($1,261/month) for a married couple. The asset limit is $2,000 for one person and $3,000 for a two-person household.

To apply for Medicaid, visit HealthCare.gov and create an account. You can then access Montana’s Medicaid Marketplace and fill out an application. Alternatively, call (800) 318-2596 to apply by phone.

What Information You Will Need

The Medicaid application will ask you to provide several pieces of information to verify your eligibility. These include:

• Name, birth date and contact information for every household member
• Proof of all income, including income from an employer, SSI payments and Social Security benefits
• Social Security numbers and/or immigration documents (only for those applying for coverage)
• Current health insurance, including Medicare or coverage through your spouse’s employer

How to Get Help Applying for Medicaid

If you need assistance with understanding Medicaid benefits or filling out your application, there are several ways to get help.

Medicare doesn’t pay for non-medical home care, but it can cover the cost of the medical version of home care, called “Home Healthcare” in some situations. In order to be eligible, you need to be homebound and have a referral from your doctor for the specific type of medical care that is needed. There are also other restrictions that apply.

Below is an overview of some of the services typically covered by Medicare for those who are eligible:

• Physical Therapy: Physical therapy is used to help patients recover from injuries (broken bones, knee injuries, etc.), and to treat ongoing conditions such as arthritis. Additionally, physical therapy is often provided in the home to help seniors recover from surgeries and procedures, such as a knee or hip replacement.
• Nursing Care: Licensed nurses can provide a number of medical services (such as wound care, changing feeding tubes, etc.) for those who need medical care, but don’t need to stay in a hospital full-time.
• Occupational Therapy: Occupational therapy is designed to help seniors regain or maintain the ability to accomplish normal, daily tasks, such as bathing, dressing, eating, etc., and providers can travel to your home if needed.
• Speech Therapy: Seniors can lose the ability to adequately communicate for many reasons, and speech therapists are there to help seniors regain the ability to communicate using a variety of means. Additionally, speech therapists help to keep seniors independent by modifying diets and teaching special techniques to swallow safely.

As mentioned above, home care is distinctly different from home healthcare, but there is some overlap – so while Medicare doesn’t cover non-medical home care, there are personal care services that may be covered in special circumstances – such as an occupational therapist helping with eating or dressing.

Read our guide to Medicare and Home Care Coverage for more information.

While the above programs can be a great way to make home care affordable for many people, they are not the right solution for everyone. Thankfully, there are other ways to make home care more affordable for you and your family. For more information about your other options, read our section on Other Ways to Pay for this guide.

Throughout Montana, you’ll find a variety of organizations and government agencies offering resources to help you safely age in place. These free services aim to help Montana seniors live in their own homes for as long as possible.

According to a January 2022 memo by the Centers for Medicare & Medicaid Services (CMS), all Montana home care workers employed by Medicare- and/or Medicaid-certified providers must comply with the federal mandate to be vaccinated against SARS-CoV-2. Non-certified providers are not legally required to comply with the order but may choose to enforce their own vaccination requirements for employees who have direct contact with patients. The rule protects the elderly by helping to prevent the spread of COVID-19.

Although this rule is current as of April 2022, rules and regulations can often change. Contact your home care provider if you have concerns about the vaccination status of staff who may enter your home. You can also contact your local AAA for the most current information on vaccination rules.

The DPHHS is responsible for the licensing and regulation of home care agencies in Montana. The state regulates care plan requirements, medication administration, staff screening, training and other rules providers must follow.

Whether you are looking for yourself or a loved one, finding a quality home care provider can be a stressful process. To help you overcome this challenge, we’ve created a helpful checklist below that can help guide you through the process of both determining your needs, and finding a home care agency that will be the best fit for you and your family.

Download PDF Here

Learn More About Home Care in Montana’s Top Cities

• Billings