Get Paid to Care for Your Elderly Parent in Montana
Montana lets you be paid to care for an aging parent through the Big Sky Waiver's self-directed services and the state's Self-Directed Community First Choice / Personal Assistance Services. Adult children are commonly hired, and Acumen Fiscal Agent handles payroll and taxes; note the Big Sky Waiver currently has a waiting list.
This guide covers what Montana family caregivers need to know: the program structure, pay rates, who can be paid, eligibility, how to apply, and other programs that may supplement your income.
Montana pays family caregivers $13–$22 per hour through the Big Sky Waiver self-directed services option within the Big Sky Waiver (1915(c) Home and Community Based Services Waiver). Your parent must meet a nursing-facility level of care but prefer to remain at home.
Montana's Main Program: Big Sky Waiver self-directed services
Big Sky Waiver self-directed services is a self-directed option within Montana's Big Sky Waiver (1915(c) Home and Community Based Services Waiver), which provides home and community-based care for seniors and adults with disabilities who meet a nursing-facility level of need. Under self-direction, your parent (or you as their authorized representative) can hire, train, schedule, and supervise the personal-care attendant — and that attendant can be you, an adult child.
What the Program Pays For
Authorized self-directed services typically include:
- Personal care: bathing, grooming, dressing, oral hygiene
- Toileting assistance and incontinence care
- Mobility help: transferring, positioning, ambulation support
- Meal preparation and feeding assistance
- Light housekeeping directly related to health and safety
- Medication reminders (not administration, which requires a nurse)
- Supervision for individuals with cognitive impairment, including dementia
Pay Rates Across Montana
| Region | Typical Hourly Rate | Notes |
|---|---|---|
| Billings / Yellowstone County | $14–$22/hr | Largest metro; self-directed personal care managed via Acumen fiscal agent |
| Missoula / Great Falls | $13–$20/hr | Self-Directed services and PAS available; adult children commonly hired |
| Rural / Eastern Montana | $13–$18/hr | Rural rates lower; note the Big Sky Waiver has a waiting list |
Rates are set within the participant's approved plan-of-care budget and the state's limits; the figures above are typical ranges, not guarantees.
Who Can Be Paid
Montana is relatively flexible: a friend or family member, including an adult child or in many self-directed situations a spouse, can be hired, with adult children most commonly paid to care for aging parents. Always confirm the current rules with Montana Department of Public Health and Human Services, Senior and Long-Term Care Division before you count on a specific arrangement.
Eligibility Requirements
Your Parent Must:
- Be enrolled in full Montana Medicaid (not just a savings program)
- Meet the clinical criteria for a nursing-facility level of care
- Be enrolled in the Big Sky Waiver (1915(c) Home and Community Based Services Waiver) (or its self-directed option)
- Live in Montana in a community setting (not a nursing home)
- Be able to direct their own care, or have a legal/authorized representative who can
You (the Caregiver) Must:
- Be 18 years of age or older
- Meet the program's relationship rules (see above)
- Pass a criminal background check and registry search
- Complete any required caregiver orientation and training
- Be legally authorized to work in the United States
- Submit timesheets through Acumen Fiscal Agent
How to Apply: Step-by-Step
- Apply for Montana Medicaid. Apply online at dphhs.mt.gov/healthcare/apply or call 1-888-706-1535. Your parent must meet income and asset limits.
- Request a long-term-services assessment. Contact your local Medicaid or aging office to request a comprehensive functional assessment that determines whether your parent qualifies for the Big Sky Waiver (1915(c) Home and Community Based Services Waiver).
- Enroll in the waiver. Once deemed eligible, your parent is enrolled in the Big Sky Waiver (1915(c) Home and Community Based Services Waiver) and assigned a case manager or care coordinator.
- Request the self-directed (BSW) option. During care planning, ask specifically for the consumer/self-directed service model and state that you, the adult child, want to be the hired caregiver.
- Enroll with Acumen Fiscal Agent. Complete enrollment paperwork — W-4, I-9, and background authorization — so payroll, tax withholding, and timesheets are handled for you.
- Complete orientation. Finish any state-required caregiver orientation covering personal-care techniques, emergency procedures, and reporting.
- Begin care and submit timesheets. Provide care per the authorized plan and submit electronic timesheets; payroll is processed on a regular cycle with taxes withheld.
Check Your Parent's Eligibility
Our free Benefits Checker helps identify whether your parent qualifies for Montana's caregiver-pay programs and other benefits.
Check Eligibility NowOther Programs That May Pay Montana Family Caregivers
VA Veteran-Directed Care & PCAFC
If your parent is a veteran enrolled in VA healthcare, the Veteran-Directed Care program provides a monthly budget that can pay family caregivers, and the Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers a monthly stipend for eligible primary caregivers. Contact the caregiver support coordinator at your parent's VA medical center or call 1-855-260-3274.
Personal Care Agreement (Private Pay)
If your parent does not qualify for Medicaid, a formal written Personal Care Agreement lets them pay you from their own funds at fair-market rates. Drafted with an elder-law attorney, it must be prospective and reasonable — and it keeps payments from being treated as "gifts" during the Medicaid 5-year look-back.
State Respite & Caregiver Support
Through the National Family Caregiver Support Program, Montana's Area Agencies on Aging fund respite, training, and counseling. These rarely pay ongoing wages but reduce your out-of-pocket costs. Find your local agency through the Eldercare Locator (1-800-677-1116) or 1-800-551-3191.
Tax Implications for Family Caregivers
- W-2 wages: The financial management agency issues you a W-2; federal income tax, Social Security, and Medicare are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent (the Medicaid waiver participant), your self-directed wages may be excludable from federal gross income. Consult a CPA before filing — see IRS guidance on Medicaid waiver payments.
- Earned Income Tax Credit: These wages count as earned income and may qualify you for the EITC.
Maintain daily logs of services provided — date, time in, time out, and a brief description. Medicaid audits self-directed arrangements, and accurate records protect both you and your parent.
What Montana Caregivers Are Actually Earning
At 30 hours per week and about $17 per hour, you would earn roughly $2,210 per month. At 40 hours per week and $22 per hour, earnings reach about $3,813 per month — around $45,760 per year before taxes.
For comparison, a nursing home costs far more per year, and agency home care runs roughly $30–$40 per hour. A self-directed arrangement lets your parent receive care from someone they trust, while you earn income that partially replaces what you may have given up to provide care.
Contact Information
- Montana Department of Public Health and Human Services, Senior and Long-Term Care Division: dphhs.mt.gov/sltc/csb/BSW/BigSkyWaiverProgram | 1-888-706-1535
- Apply for Medicaid: dphhs.mt.gov/healthcare/apply
- State aging services: dphhs.mt.gov/sltc/aging | 1-800-551-3191
- Eldercare Locator (find local help): eldercare.acl.gov | 1-800-677-1116
- Medicaid (federal): medicaid.gov
Frequently Asked Questions
Montana self-directed personal care attendants typically earn roughly $13 to $22 per hour, depending on the authorized care plan and region. The exact rate is set within the participant's approved budget and managed through the fiscal agent.
The Big Sky Waiver (BSW) is a 1915(c) Home and Community Based Services Medicaid waiver for Montana residents who are elderly or physically disabled and at risk of nursing home placement. Participants can self-direct their care and hire their own caregivers.
Montana is relatively flexible, and in many self-directed arrangements a friend or family member, including a spouse, can be hired. Most commonly, adult children are paid to care for their aging parents under the waiver.
The Big Sky Waiver, through its self-directed services option, lets family members be hired and paid for personal care or homemaker services. Montana's Self-Directed Community First Choice and PAS programs offer similar options.
Apply for Medicaid online at apply.mt.gov or through your local Office of Public Assistance, and call the Public Assistance Helpline at 1-888-706-1535. To request Big Sky Waiver services, contact Mountain Pacific at 1-800-497-8322.
Yes. A parent with dementia who qualifies for the Big Sky Waiver and meets nursing-facility level of care can self-direct services and hire an adult child for personal care. Because the waiver has a waiting list, apply as early as possible.
Related Guides
- How to Get Paid to Care for Your Parent (National Overview)
- How to Apply for Medicaid for an Elderly Parent
- Caregiver Tax Deductions 2026
- VA Benefits for Elderly Parents
- Power of Attorney for an Elderly Parent
- Medicaid Spend-Down Rules
This guide is general information, not legal or financial advice. Program names, pay rates, and eligibility rules change and vary by county — confirm details with Montana Department of Public Health and Human Services, Senior and Long-Term Care Division. Sources: dphhs.mt.gov · dphhs.mt.gov.