Self-Direction and FMS in Montana
All states: self-direction map
In short: Self-directed personal care runs through provider agencies as employer of record; the I/DD waiver also offers employer authority with Acumen as fiscal agent.
Montana self-direction at a glance
| Self-directed programs | Self-Direct CFCS and PCS, Big Sky Waiver (personal assistance and Big Sky Bonanza), the DD 0208 Comprehensive Waiver and the SDMI waiver |
|---|---|
| FMS model | Mostly agency with choice, which the state calls co-employment. The DD waiver also has an employer authority option with a fiscal agent. |
| FMS vendors | No single statewide vendor. Any enrolled CFCS/PCS provider agency for personal care. Acumen for the DD employer authority option. |
| Who is the employer | The provider agency is employer of record and the member is managing employer. In the DD employer authority option the person or a family member is the legal employer. |
| Can family be paid | Yes, with limits. Adult children and other relatives can be paid. Spouses and parents of minors only for extraordinary care, generally up to 40 hours a week. |
| EVV for self-directed workers | Yes, with no live-in exemption. Claims without compliant EVV data are denied. |
| Budget authority | No in Self-Direct CFCS and PCS. Not confirmed for the waivers. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Montana offer self-direction?
Montana offers self-direction in its two state plan personal care programs, in the Big Sky Waiver, in the Developmental Disabilities Program 0208 Comprehensive Waiver and in the Severe and Disabling Mental Illness (SDMI) waiver. All of them are run by the Department of Public Health and Human Services (DPHHS). Montana Medicaid long term services are fee for service, so no managed care plan sits between the member and the program. In most of these programs the member directs the worker while a provider agency is the worker's legal employer.
- Self-Direct Community First Choice Services (SD-CFCS): serves Medicaid members who are elderly or have disabilities, need help with activities of daily living and meet nursing facility level of care. It is run by the DPHHS Senior and Long Term Care Division, Community Services Bureau. The member, or a personal representative, has employer authority but not budget authority.
- Self-Direct Personal Care Services (SD-PCS): serves Medicaid members with a medical and functional need for help with activities of daily living who do not have to meet nursing facility level of care. It is run by the same bureau under the same manual and the same provider agencies as SD-CFCS. The member has employer authority but not budget authority.
- Big Sky Waiver, self-directed Personal Assistance Services: serves older adults and people with physical disabilities who meet nursing facility level of care. It is run by the Community Services Bureau. The member directs and trains the worker, so there is employer authority. We did not find a statement on budget authority. Waiver personal assistance adds to state plan personal care and does not replace it, and the program has a waiting list.
- Big Sky Bonanza: the member-directed option of the Big Sky Waiver, as described in the Big Sky Waiver policy manual. The member acts as managing employer, and Financial Management Services is a required service for the option. The policy that describes it is dated August 1, 2011, and we could not confirm how widely the option is used today. We did not find a statement on budget authority.
- Developmental Disabilities Program 0208 Comprehensive Waiver: serves Montanans of any age with intellectual and developmental disabilities who are enrolled in the waiver. It is run by the Developmental Disabilities Program (DDP) in the DPHHS Behavioral Health and Developmental Disabilities Division. It offers two ways to self-direct: Self-Direction with Employer Authority, offered since January 1, 2012, and Agency with Choice. The DDP pamphlet speaks of managing services and individual budgets, but no page we read states budget authority outright.
- SDMI waiver, self-directed Personal Assistance Service: serves adults with a severe and disabling mental illness whose needs go beyond state plan personal care. It is run by the Behavioral Health and Developmental Disabilities Division. The member may self-direct personal assistance, with a provider agency as co-employer. We did not find a statement on budget authority.
Employer authority means the member recruits, selects, trains, supervises and dismisses the worker. Budget authority means the member also manages a set amount of money, including what the worker is paid. DPHHS's guide to accessing self-direct services says SD-CFCS and SD-PCS do not include budget authority. To self-direct in those two programs, the member or a personal representative must have the capacity to direct care. A health care professional certifies that capacity every year.
A note on names: DPHHS renamed these personal care programs from CFC/PAS (Personal Assistance Services) to CFCS/PCS, so older state documents still use the earlier terms.
Who handles financial management services (FMS) in Montana?
Montana has no single statewide FMS vendor. In the personal care programs, the Big Sky Waiver and the SDMI waiver, a provider agency the member chooses does payroll and taxes and is the worker's employer of record. In the Developmental Disabilities Program's employer authority option, the person or a family member is the legal employer, and DDP lists Acumen as its Fiscal Management Services vendor.
The state calls the main arrangement co-employment. Elsewhere it is known as agency with choice. The provider agency is the employer of record, which means it handles hiring paperwork, payroll, tax withholding, workers' compensation and unemployment insurance. The member is the managing employer, which means the member finds the worker and directs the day to day work.
- Self-Direct CFCS and PCS: the attendant must be enrolled with and employed by a state-approved CFCS/PCS provider agency. The member picks the agency. DPHHS does not post a list of these agencies online. It points members to its Regional Program Officers (406-444-4564), Mountain Pacific or local aging services for one.
- Big Sky Waiver personal assistance: the personal assistant is an employee of a provider agency under contract with DPHHS for Big Sky Waiver services, and the member directs and trains the worker.
- Big Sky Bonanza: policy BSW 713 says a Financial Manager agency, certified by the Community Services Bureau, is the common law employer of record. We did not find a current list of Financial Manager agencies. Ask the Community Services Bureau at (406) 444-4077.
- Developmental Disabilities Program, Employer Authority: the individual or a family member is the legal employer. A fiscal agent handles the payroll side, and a support broker can help with the employer role. DDP encourages a support broker for the first year. DDP's self-direction page lists Acumen as the Fiscal Management Services vendor, and Acumen's Montana page posts a pay schedule for July 2026 to June 2027. We did not find any other fiscal agent listed for this option.
- Developmental Disabilities Program, Agency with Choice: a provider agency is the legal employer, and the individual has more say over what, when, who and how. The provider list posted by DDP is dated 2016, so ask DDP at (406) 444-2995 for current providers.
- SDMI waiver: an enrolled personal care provider agency is the co-employer with the member.
Because SD-CFCS and SD-PCS have no budget authority, the member cannot set pay or offer benefits. The provider agency sets and pays the attendant's wage. The DPHHS guide tells members to ask agencies whether they take part in the Direct Care Wage Initiative and the Healthcare for Healthcare Workers initiative, since wages and benefits differ from one agency to the next.
Who can be a paid caregiver under self-direction in Montana?
Adult children and other relatives can be paid as personal care attendants in Montana's CFCS and PCS programs. A spouse, a parent of a minor child or a guardian of a minor can be paid only in limited cases. Montana calls these people legally responsible individuals, and the rules for them depend on the program.
Important: A member who receives Personal Care Services only, without meeting nursing facility level of care, cannot use a legally responsible individual as a paid caregiver. The member would need to be screened again and meet level of care for Community First Choice.
- Community First Choice (CFCS): a legally responsible individual can be paid only when the member needs extraordinary care and the arrangement is needed for health and welfare or to avoid institutionalization. The hours are generally capped at 40 a week. The caregiver must be employed by a provider agency and cannot also be the member's personal representative. DPHHS's January 2025 provider newsletter says this began as a COVID flexibility and became permanent effective May 12, 2023.
- Big Sky Waiver: under policy BSW 604-1, parents of members under 18 and spouses can be paid for listed services only if the service is needed to avoid institutionalization and is not something the family would ordinarily do. They must be employed by a Medicaid provider and can provide no more than 40 hours in seven days. For parents, that limit is combined across both parents and all children. State plan personal assistance may never be authorized through the waiver just so a legally responsible individual can be paid.
- SDMI waiver: relatives or legal guardians who provide personal assistance must be employed by a provider agency (policy SDMI HCBS 360). A separate SDMI policy covers payment to legally responsible individuals. We did not review it, so ask the member's case manager.
- Developmental Disabilities Program 0208 waiver: we did not find the rule in force today on paying legally responsible individuals, relatives or guardians. Ask DDP at (406) 444-2995.
- Big Sky Bonanza: we did not find a separate family rule for this option.
Does EVV apply to self-directed workers in Montana?
Yes. Electronic visit verification (EVV) applies to self-directed services in Montana, including when the attendant lives with the member. Since July 1, 2024, claims for EVV services that lack compliant EVV data are denied. Montana offers a free state system, Netsmart Mobile Caregiver+, and allows certified alternate systems that send visits to it.
- Self-Direct CFCS and PCS: EVV is required for all services except mileage. The attendant clocks in and out, the member or personal representative approves the visits electronically, and the agency cannot submit the claim until the time is approved.
- Big Sky Waiver and SDMI waiver: the state's list of services subject to EVV includes the self-directed personal assistance codes for both waivers.
- Developmental Disabilities Program: self-directed respite is on the state EVV list. The DPHHS EVV FAQ says self-direct employers who use Acumen as fiscal intermediary use Acumen's DCI system as their alternate EVV, and it feeds the state aggregator. Agency with Choice agencies pick the state system or their own certified alternate.
- Live-in caregivers: there is no live-in caregiver exemption. DPHHS's full compliance notice sets the claim denial rule.
Two points could not be confirmed. We did not find a state source that says a self-directed worker's own paycheck is held when a visit is not verified. The state rule we found is about the claim. Whether pay is held would be a matter for the provider agency or the fiscal agent, so ask them. We also did not find an EVV statement specific to Big Sky Bonanza. EVV questions can go to DPHHS at EVVQuestions@mt.gov.
What is changing next for self-direction in Montana?
As of the last check on October 13, 2026, we did not find an upcoming change to Montana's self-direction programs or to who provides financial management services. One related item is worth watching. DPHHS plans to replace its claims system, and it has said the EVV decision for live-in caregivers can be looked at again after that.
DPHHS's claims modernization page describes a planned move to the Montana Healthcare Claims System in 2027. No exact date has been published, and the timing could move. The DPHHS EVV FAQ says the live-in caregiver decision can be revisited once the new system is in place. That is a possibility, not a commitment. Until DPHHS says otherwise, live-in attendants record visits in EVV like everyone else.
Two smaller items:
- The self-direct CFCS/PCS policy manual shows its EVV policy, its fraud, waste and abuse policy, and its section on person-centered planning as revised in July 2026. Provider agencies should work from the current versions.
- The Big Sky Waiver page lists a waiver amendment posted for public review, dated December 16, 2025. We did not review what it contains or whether it has been approved. Check that page, or ask the Community Services Bureau, to see whether it touches self-direction.
Get notified when Montana self-direction rules change
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Who to ask about self-direction in Montana
Questions about self-direction in Montana are best put to the state. Start with DPHHS Community First Choice Services / Personal Care Services (agency-based and self-direct options). Published contact: Senior and Long Term Care Division (406) 444-4077; CFCS/PCS Regional Program Officers 406-444-4564; Developmental Disabilities Program central office (406) 444-2995.
Montana self-direction sources
- Montana DPHHS: Community First Choice Services / Personal Care Services
- Montana DPHHS: Accessing Community First Choice Services (self-direct guide)
- Montana Healthcare Programs: Claim Jumper provider newsletter, January 2025
- Montana DPHHS Developmental Disabilities Program: Self-Direction
- Big Sky Waiver policy BSW 722: Personal Assistance Services
- Big Sky Waiver policy BSW 604-1: payment to legally responsible individuals
- Big Sky Waiver policy BSW 713: Financial Management Services
- Montana DPHHS: EVV frequently asked questions
- Montana Healthcare Programs: EVV full compliance deadline provider notice
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- Montana EVV requirements
Page history
- October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
