I/DD Waivers in Montana

All states: Medicaid disability services map

Montana I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Montana?

The Developmental Disabilities Program (DDP) runs I/DD services in Montana. DDP sits in the Behavioral Health and Developmental Disabilities (BHDD) Division of the Department of Public Health and Human Services (DPHHS), which is also the state Medicaid agency, so one department both runs and pays for the program. Case management comes mainly from a contracted agency, AWARE, Inc., with some state case managers.

• Developmental Disabilities Program (DDP): operates the 0208 Comprehensive Waiver. DDP regional staff decide eligibility and level of care, select people from the waiting list and oversee providers.
• Front door: people and families start with the nearest DDP Regional Office. Offices are in Glasgow, Miles City, Great Falls, Billings, Helena, Butte, Missoula and Kalispell.
• Case management: targeted case management (TCM) is provided mainly by AWARE, Inc. under contract, with state DDP case managers in some regions. There is no waiting list for case management. The case manager writes the yearly Personal Supports Plan, which is the person's plan of care, and enters the approved services into the Medicaid payment system.

What Medicaid waivers and programs serve people with I/DD in Montana?

Montana has one Medicaid waiver for people with developmental disabilities: the 0208 Comprehensive Waiver, control number MT.0208. It is a 1915(c) waiver, a federal Medicaid option that lets a state pay for home and community services instead of institutional care. It has run since 1981 and serves eligible Montanans of any age.

• 0208 Comprehensive Waiver (1915(c), MT.0208): serves people with a developmental disability, meaning an intellectual disability, cerebral palsy, epilepsy, autism or a closely related condition that began before age 18 and causes substantial limitation. People must be Medicaid eligible and meet the level of care for an intermediate care facility for individuals with intellectual disabilities (ICF/IID). The current approved document is amendment MT.0208.R07.01, effective November 12, 2023, of a renewal that began July 1, 2023, according to the waiver document.
• Main services: residential habilitation (group homes and supported living), adult foster support, assisted living, day supports and activities, retirement services, supported employment, personal supports, personal care, companion and homemaker services, respite, caregiver training, behavioral support, remote monitoring, private duty nursing and therapies, supports brokerage and transportation.
• Limits: the waiver serves up to 2,880 people a year and 2,777 at any one time.
• Targeted case management: a separate Medicaid service for people 16 and older who are enrolled in or found eligible for the waiver (including people on the waiting list), and for children under 16 enrolled in the waiver.

The waiver document says Montana's ICF/IID has closed, so the waiver is the main way Medicaid funds long-term I/DD supports in the state.

Does Montana pay for I/DD services through managed care?

No. Montana pays for I/DD waiver services fee-for-service. Providers bill Montana Medicaid through its claims system and are paid directly by the state, according to the waiver and the DDP Rates and Billing Manual.

• Who authorizes services: the case manager builds a cost plan from the Personal Supports Plan and enters it as service authorizations in the Medicaid system.
• Who coordinates services: the targeted case manager, mostly from AWARE, Inc.
• Who pays claims: Montana Medicaid. There are no health plans in between.

Is there a waiting list for I/DD services in Montana?

Yes. Everyone found eligible for DD services is placed on a statewide waiting list for the 0208 waiver automatically, and people are selected mainly by how long they have waited. DPHHS put the list at about 1,700 people in a DDP overview prepared for November 2024. We did not find a newer count from the state.

• Order of selection: people are chosen in order of time on the list, except for reserved slots. Since July 2015, people go on the list automatically once found eligible.
• Reserved slots each year: 40 for people in crisis, 30 for people moving out of institutions (including the Intensive Behavior Center in Boulder) and 12 for youth leaving Child and Family Services custody.
• While waiting: people 16 and older on the waiting list can receive targeted case management, which has no waiting list.

For a current count or a person's place on the list, ask the DDP central office at (406) 444-2995 or the local DDP Regional Office.

How do people apply for I/DD services in Montana, and how are budgets set?

A person or family contacts the nearest DDP Regional Office, which sends a checklist of documents to gather. DDP's Eligibility Specialist decides eligibility. Eligibility is not based on income, but waiver services require Medicaid eligibility. Once a slot opens, the person's budget and service tiers are set using the Montana Resource Allocation Protocol (MONA).

• Help applying: people 16 and older can ask AWARE, Inc. for a targeted case manager to help collect documents.
• Eligibility for age 8 and older: a recent psychological evaluation with an IQ of about 70 or below, or records of a closely related condition such as cerebral palsy, epilepsy or autism that began before 18, plus a Vineland Adaptive Behavior assessment done by a DDP Quality Improvement Specialist.
• Children under 8: can be found provisionally eligible through Eligibility Review Panels at regional Part C (early intervention) agencies. They must be confirmed before their 8th birthday to stay on the list.
• Budgets: the case manager completes the MONA, which sets the cost plan and the daily rate tiers for services like group homes and day supports.

What day and residential services can I/DD providers offer in Montana?

Under the 0208 waiver, providers can offer day supports, retirement services and supported employment, plus four residential options: group homes, supported living, adult foster support and assisted living. Group homes, day supports, retirement services and small group employment are paid as daily rates in tiers based on the person's average daily support hours. Dollar figures below come from the posted July 1, 2026 rates manual, which DPHHS labels a draft.

Day and employment services

• Day Supports and Activities: skill building and community inclusion during typical working hours, for any age. Paid daily in 13 tiers ($14.49 to $255.70 a day), or hourly above about 8 average hours, with transportation included. It cannot be billed at the same time as supported employment. No facility license is named in the waiver; the provider must be a DDP qualified provider meeting state DD staffing rules (staff at least 17, background checks, first aid and CPR, and abuse and incident reporting training within 30 days). The research did not find a published staff ratio.
• Retirement Services: keeps people of retirement age active in their community. Paid daily in 13 tiers ($13.75 to $242.57 a day) or hourly for higher needs. The research did not find a published ratio or license.
• Supported Employment: help getting, keeping or advancing in a job. Individual support is hourly. Small group support covers groups of 2 to 8 workers and is paid in daily tiers or hourly. Follow-along support is monthly or hourly, and co-worker support is paid per day at work. Follow-along and co-worker support can be self-directed.

Residential services

• Congregate living (group homes): licensed group homes and shared supported living sites with awake staff on all shifts, paid in 10 daily tiers ($140.31 to $596.84) or hourly, with separate rates for medical and children's group homes. Group homes must be licensed by DPHHS as community homes for persons with developmental disabilities. Under a 2025 change to state law, a community home serves 2 to 6 residents, with a waiver possible for homes licensed before October 1, 2025. Room and board is not covered.
• Supported living: support for people in their own home, a family home or an apartment, with 24-hour on-call staff. Billed monthly or hourly, with geographic and small-agency add-ons and a rural remote rate.
• Adult foster support: Montana's shared living option. A licensed adult foster care provider who lives in the home is paid a monthly stipend at four supervision levels ($3,423.63 to $5,351.82), and residential training supports are billed hourly on top. No more than four unrelated members may live in the home.
• Assisted living: pays for a person with a developmental disability to live in a licensed assisted living facility, at a moderate or enhanced daily rate.

How are I/DD provider rates set and how do agencies enroll in Montana?

DPHHS sets a statewide fee schedule in the DDP Rates and Billing Manual and adopts it by rule. The rates were rebuilt from a 2021 to 2022 rate study and change mainly when the Legislature funds an increase. The last increase took effect July 1, 2025, and the draft July 1, 2026 manual keeps every DD waiver rate at that level. New providers follow DDP's Qualified Provider Process.

• Rate method: the rate study by Guidehouse built each rate from costs such as wages, benefits, supervision, administration and mileage. Rates were funded at about 69.5% of the gap between old rates and the study's benchmark, and were made permanent in the November 2023 waiver amendment.
• Latest change: increases funded by the 2025 state budget bill (HB 2) were adopted retroactive to July 1, 2025, projected at $5.26 million in state fiscal year 2026 across 84 active providers, according to the rule notice. DDP posts rate information on its rates page.
• Becoming a provider: DDP's Qualified Provider Process uses the 0208 Comprehensive Waiver Provider Manual (effective July 1, 2024) and Montana Medicaid provider enrollment. Agencies start by contacting a local DDP office.
• EVV: electronic visit verification (EVV) applies to 0208 in-home services: personal care, companion, respite, private duty nursing, therapies and nutritionist services. Visits are recorded in the state's Netsmart Mobile Caregiver+ system or a certified alternate. Since July 1, 2024, claims for these services without compliant EVV data are denied, according to the DPHHS EVV page. EVV does not apply in congregate settings such as group homes.

What is changing next for I/DD services in Montana?

Montana is piloting a new needs assessment, the Supports Intensity Scale for Adults (SIS-A) 2nd Edition, with 500 waiver members from fall 2026 into early 2027. DPHHS plans to use the results to set rates by level of need, and it estimates those rates around late 2029. That date is an estimate, not a final decision, and current rates stay until then.

• SIS-A pilot: DPHHS contracted with AAIDD, the group that publishes the SIS-A, for 500 pilot assessments of randomly selected members 16 and older. A stakeholder session was set for October 29, 2026, according to the Behavioral Health System for Future Generations page. The state's SIS-A FAQs say it is also looking for a tool to replace the MONA.
• Other planned work: DPHHS also reports work on a START crisis program pilot, crisis training, a pilot of small intensive community homes, a new procurement for evaluation and diagnostic clinics, and value-based payment for DD case management. These are in progress and dates are not final.

We did not find a filed amendment to the 0208 waiver since November 2023. For news on waiver changes, ask DDP at (406) 444-2995.

Montana I/DD sources

• Montana DPHHS: Medicaid DDP 0208 Waiver Services
• Montana DPHHS: DDP Medicaid waivers
• 0208 Comprehensive Waiver (amendment effective November 12, 2023)
• Montana DPHHS: DDP overview, November 2024 tribal consultation
• Montana DPHHS: Targeted Case Management services
• Montana DPHHS: DDP Rates and Billing Manual, effective July 1, 2026 (draft)
• Montana Administrative Register Notice 2025-129.1 (DD rates)
• Montana DPHHS: DDP Qualified Provider Process
• Montana DPHHS: Electronic Visit Verification
• Montana DPHHS: Behavioral Health System for Future Generations approved recommendations

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Montana EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.