How Montana pays for disability services

Waiver inventory

Current 0208 waiver document, effective November 12, 2023: dphhs.mt.gov

Full 0208 service list with self-direction flags: dphhs.mt.gov

State-only funded programs

• Intensive Behavior Center (IBC), Boulder. The state's remaining congregate facility serving people with developmental disabilities and significant behavioral needs, appropriated in HB2 under the Health Care Facilities Division. FY2026 request $7,602,766; FY2027 $7,630,980. 44.41 FTE requested against an FY2024 population of 8.98 residents, an average annual per-resident cost of $848,204. The LFD table does not break out the fund source, so I cannot confirm this is 100% state dollars; it is state-operated and state-appropriated. leg.mt.gov
• Behavioral Health System for Future Generations (BHSFG) state special revenue fund. HB 872 of the 2023 Session transferred $225.0 million into this fund plus $75.0 million into the capital development fund, explicitly for "stabilizing, studying, and continuing to develop a viable and comprehensive statewide behavioral health and developmental disabilities care system," per 50-1-119 MCA. The BHSFG Commission's September 2024 report made 22 recommendations; ten were carried into the executive budget request, amounting to $30.0 million state special revenue in FY2026 and $23.5 million state special plus $45.5 million federal in FY2027. This is state money, though several recommendations leverage federal match. leg.mt.gov
• Montana Milestones (Part C, IDEA Early Intervention), birth to age three, administered by the Early Childhood and Family Services Division. Not state-only: mixed general fund and federal. The FY2026-27 budget adds $1,386,541 general fund plus $627,881 federal in FY2026 and $1,620,078 general fund plus $707,842 federal in FY2027 for a Part C provider rate increase implementing the Guidehouse Provider Rate Study of October 2023. Same source.
• None otherwise identified. I specifically looked for a state-funded Family Education and Support Services line or a non-Medicaid DDP family support appropriation. Checked: the DPHHS DDP program pages, the DDP Rates Information page, the DDP Provider Resources page, the DDP Forms and Tools page, the DDP Eligibility Reference Manual, the LFD Behavioral Health and Developmental Disability addendum, and the LFD Section B full report. The DDP Eligibility Reference Manual states plainly that "Developmental disabilities services provided by the State of Montana are almost entirely delivered through Medicaid funded home and community services programs." dphhs.mt.gov

County / regional / local funding

None identified. Montana has no county levy, county DD board, or local mill levy for developmental disability services in any source reviewed. DDP is administered centrally from Helena with regional offices in Glasgow, Great Falls, Billings, Helena, and Missoula plus satellites in Miles City, Butte, Bozeman, and Kalispell; those are state offices administering state and federal dollars, not local funding entities, and eligibility determination is centralized to a single Eligibility Specialist in Helena. Checked: DPHHS DDP pages, the LFD 2027 biennium budget analysis, and the DDP eligibility manual.

Funding scale

• 0208 waiver: approximately 2,500 people served, with average individualized support cost of $72,000 annually and "a large range across individuals." Over 30 service types. leg.mt.gov
• Implied 0208 waiver spending: approximately $180 million per year (derived: 2,500 × $72,000). This is my own multiplication of two LFD figures, not a published total.
• Behavioral Health and Developmental Disabilities Division (BHDD) total, all funds: FY2023 actual $463,175,316; FY2024 actual $521,228,308; FY2025 base $565,103,283; FY2026 requested $579,851,227; FY2027 requested $642,461,191. BHDD 2027 biennium appropriations are approximately $92.1 million, or 8.1%, above the FY2025 base. Note this covers adult and children's mental health, substance use, suicide prevention, and DDP together; a DDP-only total is not broken out. Same source.
• BHDD FY2026 fund split: general fund $153,479,833; state special $64,495,293; federal special $361,876,101. FY2027: $161,713,362 / $57,976,304 / $422,771,525.
• Traditional Medicaid plus Medicaid expansion in BHDD totals $1,141.9 million in benefits and claims over the 2027 biennium, of which traditional Medicaid is $938.7 million.
• Community First Choice served 3,624 people as of FYE 2024, at a federal match six percentage points above Montana's regular FMAP. leg.mt.gov
• Montana FMAP FY2026: 61.47%. CFC effectively runs at 67.47%. kff.org The budget analysis notes FMAP adjustments raising general fund obligations for traditional Medicaid by $8.6 million in FY2026 and $9.1 million in FY2027, with additional state special revenue adjustments of $2.5 million and $2.6 million.
• Waiting list: 2,095 people with I/DD waiting in 2025 (1,749 in 2024; 2,382 in 2023). Secondary. kff.org
• Average wait: approximately seven years, with a waitlist of approximately 2,500 to 3,000 slots, and allocation strictly by time on the list. Secondary and dated to October 2020, from the University of Montana Rural Institute's Montana Family to Family center. umt.edu
• The 0208 renewal presentation confirms DDP requested "more emergency waiver slots" to let people in crisis move ahead of the existing list. dphhs.mt.gov
• Not found: a published DDP-only expenditure total, a state versus federal split isolated to DDP, an official DPHHS waitlist count, or an official average wait time.

Residential funding detail

Montana runs the most explicitly acuity-tiered residential rate structure of the three states, driven by assessed average staff hours per day. Rates below are effective July 1, 2025 from the DDP Rates and Billing Manual.

Congregate Living (T2017), licensed group homes and congregate supported living sites where members share staff. Paid per diem across nine hour-banded tiers, converting to an hourly rate above 10.95 average hours per day. Rates include member transportation.

• Tier 1 (1 to 4.8 average hours/day, 0 to 1,735.99 annual hours): $140.31/day
• Tier 2 (4.9 to 5.47): $165.43 | Tier 3 (5.48 to 6.14): $186.45 | Tier 4 (6.15 to 7.14): $213.19
• Tier 5 (7.15 to 7.7): $239.44 | Tier 6 (7.8 to 8.43): $259.97 | Tier 7 (8.44 to 8.75): $274.87
• Tier 8 (8.76 to 9.9): $299.45 | Tier 9 (10 to 10.95): $334.56 | Tier 10 (modifier HI): $596.84/day
• Congregate Living Hourly (above 10.95 average hours/day): $31.44 per staff hour
• Congregate Living Medical (designated licensed group home sites with 24/7 LPN on site; LPN and habilitation staff both billable): $36.40 per staff hour
• Congregate Living Children's: $34.17 per staff hour
• Retainer days: up to 30 per year, prorated by quarter of entry (30 days if starting July-September, 22 October-December, 15 January-March, 8 April-June). Modifier KX. Not available while a person is admitted to Montana State Hospital.
• Congregate Living homes must have awake staff on all shifts where individuals are present.

Residential Habilitation Supported Living (T2013), hourly, in a person's own or family home, with a geographic factor and a small agency adjustment:

• Standard agency: $33.59 (no geo factor) / $34.43 (medium) / $35.27 (high) per staff hour
• Small agency: $43.66 / $44.75 / $45.85 per staff hour
• Rural remote (round trip of at least 80 miles from the nearest provider location, or more than 45.1 hours of supported living per month, prior approval required): $36.11 per staff hour

Supported Living monthly options (T2032), for people whose needs vary month to month, requiring at least one face-to-face contact per month (telehealth does not satisfy this):

• Base (1 to 30.99 hours of support per month): $1,007.65/month
• Flex: $1,511.47/month

Adult Foster Support (S5141), host home model, paid monthly by supervision level:

• Low supervision: $3,423.63/month | Moderate: $3,900.15 | Enhanced: $4,376.66 | Intensive: $5,351.82
• Supervision levels are defined by physical proximity and intervention requirements, from "aware of the location of the person and available to physically assist" through "able to physically intervene with the person at all times."
• Separate payment is not made for homemaker, chore, personal supports, or residential training within Adult Foster.
• Residential Training Supports (H2015) is billable only for someone receiving Adult Foster, billed separately, at the same rate ladder as Supported Living: $33.59 / $34.43 / $35.27 standard, $43.66 / $44.75 / $45.85 small agency, per staff hour.

Assisted Living (T2031), per day, by staffing ratio: moderate (1:4 to 1:8 ratio) $222.08/day; enhanced (1:1 to 1:3 ratio) $296.10/day.

Service exclusions in residential. People in residential habilitation may not receive Personal Supports, Homemaker, Environmental Modifications, Respite, Meals, Adult Foster, or Assisted Living under HCBS while the residential payment is being made. Companion services cannot be added where the setting already provides 24/7 care (group homes, assisted living, adult foster, congregate supported living), though Companion can form part of a 24/7 package alongside residential habilitation.

Institutional. The Intensive Behavior Center in Boulder is the state congregate facility, at an FY2026 appropriation of $7,602,766 for a FY2024 population of 8.98, an average of $848,204 per resident per year.

Room and board. Not paid by the waiver. The DDP Rates and Billing Manual contains no room and board line item and no rent or board payment code; residential rates are described as covering staff support and member transportation. Residents' SSI and other income cover housing costs. No state room-and-board subsidy was identified in the Montana documents reviewed.

Comparable service rates

All rates from the Montana DDP Rates and Billing Manual effective July 1, 2025, except case management, which is from the July 2025 TCM Rate Manual.

Additional rates of interest, all effective 7/1/2025: Behavioral Support Services (H0046) not restated in the 2025 manual excerpt reviewed but priced at $92.39/staff hour in the 7/1/2024 summary sheet; Caregiver Training and Support (T1027) $59.08/staff hour (7/1/2024); Supports Broker (T2041) $41.34/staff hour (7/1/2024); Remote Monitoring Equipment (A9279) $300 maximum per month; Meal Services (S5170) $8.97 per meal (7/1/2024); mileage (S0215) $0.59 per mile (7/1/2024).

Official rate schedule links

• DDP Rates and Billing Manual, effective July 1, 2025 (the authoritative current rate document): dphhs.mt.gov (also listed as dphhs.mt.gov)
• Targeted Case Management Rate Manual, effective July 2025: dphhs.mt.gov
• TCM Rate Manual, July 2024: dphhs.mt.gov
• TCM Rate Manual, July 2023: dphhs.mt.gov
• DDP Waiver Summary Rate Sheet, effective 7/1/2024 (spreadsheet with every code, modifier, unit and maximum fee): dphhs.mt.gov
• DDP Services Manual v2, effective July 1, 2023: dphhs.mt.gov
• Corrected Fiscal Agent Fee Schedule, effective 7/1/2020: dphhs.mt.gov
• DDP Rates Information index: dphhs.mt.gov
• Montana Medicaid provider fee schedules portal: medicaidprovider.mt.gov

Notable features and flags

• July 1, 2025 rate increase across DDP services, roughly 3% on most codes. Congregate Living Tier 1 rose from $136.22 to $140.31; Tier 10 from $579.46 to $596.84; Supported Living from $32.61 to $33.59 per staff hour; Adult Foster low supervision from $3,323.91 to $3,423.63 per month; Personal Care from $8.92 to $9.19 per 15 minutes; Respite from $6.02 to $6.20; Supported Employment from $57.49 to $59.21 per staff hour; Assisted Living moderate from $215.61 to $222.08 per day.
• 0208 waiver renewal effective November 12, 2023. The renewal expanded behavioral services (adding a highly trained, highly paid behavioral technician tier and Registered Behavior Technician rates), added remote monitoring with privacy safeguards, allowed DDP providers to subcontract adult foster care, permitted parents and spouses to be paid for "Extraordinary Care Needs" in residential habilitation, and requested additional emergency waiver slots for people in crisis.
• HB 872 (2023 Session) put $225 million into the Behavioral Health System for Future Generations fund covering both behavioral health and developmental disabilities. The commission's September 2024 report produced 22 recommendations; ten made the executive budget, at $30.0 million state special in FY2026 and $23.5 million state special plus $45.5 million federal in FY2027. Recurring costs must be absorbed into the base budget in future biennia, which is the main sustainability risk to watch.
• Guidehouse Provider Rate Study, October 2023, is the reference point for Montana provider rate setting. The state entered new Part C contracts at Guidehouse-recommended rates; the FY2026-27 budget funds that adjustment at $2,014,422 in FY2026 and $2,327,920 in FY2027 all funds.
• FMAP pressure. Montana's 61.47% FY2026 FMAP is among the lower rates in this set, and the LFD analysis books $8.6 million (FY2026) and $9.1 million (FY2027) of additional general fund obligation from FMAP adjustment alone, plus $2.5 million and $2.6 million in state special.
• Long waits are the defining feature. Approximately 2,095 to 3,000 people are waiting, with an average wait reported at roughly seven years and allocation by date on the list rather than by need, apart from a small emergency-slot channel. Montana serves approximately 2,500 people on the 0208 waiver, so the waiting population is close to the size of the served population.
• Self-direction is well developed: modifier SC marks self-directed billing, with Personal Supports, Supports Broker, Respite, Individual Goods and Services, Supported Employment, Community Transition, Specialized Medical Equipment and Supplies, Environmental Modifications, Meals, PERS, and Transportation all self-directable. Modifier CG covers services delivered by a legally responsible individual, which the 2023 renewal expanded. dphhs.mt.gov
• Children's Autism Waiver terminated, leaving no autism-specific waiver; children under 8 are served through Montana Milestones Part C and children 8+ through the 0208 waiver.

Confidence

Solid: every rate in this profile was read directly out of the Montana DDP Rates and Billing Manual effective July 1, 2025 and the July 2025 TCM Rate Manual, downloaded and parsed from DPHHS. The tier definitions, retainer-day rules, geographic and small-agency adjustments, service exclusions, and supervision-level definitions are quoted from that manual. The 0208 enrollment figure (approximately 2,500), the $72,000 average annual per-person cost, the BHDD budget tables, the CFC enrollment (3,624 as of FYE 2024), the Intensive Behavior Center figures, the BHSFG $225 million transfer, and the FMAP adjustment dollar amounts all come from the Legislative Fiscal Division's 2027 biennium budget analysis, read directly. Estimated or derived: the approximately $180 million implied annual 0208 waiver spend is my multiplication of two LFD figures and is not a published number; treat it as an order-of-magnitude estimate. Secondary and dated: the waiting list characterization. KFF gives 2,095 for 2025; the University of Montana Family to Family page gives 2,500 to 3,000 slots and a roughly seven-year average wait as of October 2020, and no current DPHHS waitlist publication was located. Could not find: a DDP-only expenditure line separated from the rest of BHDD, an official DPHHS waiting list count or average wait, a Montana Medicaid DD fee schedule on the medicaidprovider.mt.gov portal (the DDP manual is the operative rate document instead), or any state-funded non-Medicaid DD family support program. The Intensive Behavior Center's fund source is not broken out in the LFD table, so its characterization as state-only is inferred from its state-operated status, not documented.

I have the data I need. Here are the three profiles.