Waiver Services

When people say their child is on the waitlist for ‘services’ in Montana, most likely they’re referring to the waitlist for a Home and Community-based Services waiver.  Montana has two primary waiver programs:  the Montana Big Sky Medicaid Waiver and the Comprehensive Waiver 0208. 

The waiver programs make it possible to receive services in the community, in a private home or group home. Individuals who otherwise might require an institutional level of support can, through waiver, pay for goods, services, equipment, and staff that allow them to be home. 

Once your child receives a waiver slot, he is also considered a ‘household of one.’ This means he will qualify for health coverage through Medicaid regardless of family income.

If your child has both a physical disability and a developmental disability, it could be worth your time to get on both waitlists. For example, should your child receive the Big Sky waiver, then rise to the top of the 0208 list, you can choose which waiver will best meet current and future needs.

Following are answers to frequently asked questions about waiver.  For answers specific to your situation, contact your regional office directly.

0208:  Approximately 2,500 - 3,000

Big Sky:  Approximately 2,500.

0208:  People receive the 0208 Waiver based on how long they have been on the waitlist.  Additional waiver slots are reserved each year to be used to address crises or emergencies. These are tightly controlled and for worst case scenarios.

Big Sky:  People do not receive Big Sky Waiver chronologically. Rather, an available opening for services will be offered to the waitlisted person determined most in need of the service and most likely to benefit from the available services.

0208:  The 0208 Waiver serves those with developmental or intellectual disability.

Big Sky:  The Big Sky Waiver serves Montanans who have physical disabilities, including disabilities associated with aging. Find eligibility criteria here:  https://dphhs.mt.gov/Portals/85/sltc/documents/BigSkyWaiver/HCBSPolicyManual/400/BSW406(2).pdf

A child can be on both waitlists if he meets the eligibility requirements both lists require.

If your child receives the Big Sky waiver, he can still remain on the waitlist for the 0208 and you can exchange one for the other (should you get the opportunity). Your child cannot be on the Big Sky Waiver waitlist if he is served by any other waiver.

0208:  There is only one waitlist.

Big Sky:  There is only one waitlist.

To get on the waitlist for the 0208 Comprehensive Waiver (developmental disability):

Under Age 8: A child is referred to 0208 waiver services by area agencies. To find the agency serving your area that can help you get started, go to the Milestones page at the Montana Department of Public Health and Human Services and click on the link for “List of Part C and Family Education and Support Program Providers.”

Over Age 8: The Developmental Disabilities Program has an eligibility specialist in the central office in Helena. As of 10/2021, the eligibility specialist is Lisa Nehl. Contact Lisa at (406) 444-5930.  You can also contact your Regional DDP office for information on eligibility (https://dphhs.mt.gov/BHDD/DisabilityServices/developmentaldisabilities/DevelopmentalDisabilitiesRegionalOffices).

To get on the waitlist for the Big Sky Waiver (elderly or physical disability), the process is the same regardless of age:

The screening process begins with Mountain Pacific Quality Health (MPQH). Medicaid eligibility is not required for that process. Then, once the Big Sky Waiver case management team receives the screening results from MPQH, the team reaches out to the applicant/family and explains the criteria for enrollment into the program (including financial eligibility for Medicaid).Similar to 0208 waiver, the Big Sky waiver has different financial eligibility rules than standard Medicaid.

Contact Mountain Pacific Quality Health at 1-800-219-7035 to get started.

0208:   Call your regional Developmental Disability Program office.  https://dphhs.mt.gov/dsd/developmentaldisabilities/developmentaldisabilitiesregionaloffices

Big Sky:  If your child is denied placement on the Big Sky waitlist, you will be provided with written notification which will include instructions on how to appeal that decision.

0208: On average, as of October 2020, the wait for 0208 Waiver is approximately seven years – again, this is a best guesstimate. Waiver slots are not necessarily a 1:1 proposition, meaning when one slot opens up, that does not mean one slot will be assigned to a new recipient.  Waiver slots are funded according to individual needs. A newly opened slot could mean the equivalent of several new slots if it was heavily funded; of course, the reverse is also true.   

Big Sky:  The current average wait list stay is 125 days; however, individuals are not offered a slot based on first come - first served.

*It is difficult to assess how slowly or quickly movement occurs on the waitlists. Many factors contribute to movement: how many people leave services (move, pass away, go to a nursing home), if the Legislature appropriates any money specifically to decrease the wait lists,  and whether the state’s waiver programs increase the target number of people served  (this only occurs if money becomes available).

0208:  Your child can lose the waiver if he moves out of state, if he does not maintain Montana Medicaid eligibility,  if the waiver cannot meet his health and safety needs, or if health is failing to the point that his needs exceed a group-home level of care.

Big Sky:  An individual must continue to meet program eligibility requirements to remain in the program.

0208:  Your case manager should be able to get this information for you. If not, call the Developmental Disability Program office in your region.


Big Sky:  Your child’s Big Sky Waiver case manager should be able to provide this information; however, individuals are not offered a slot based on first come - first served.