Montana 0208 Comprehensive Waiver

What the 0208 Waiver Covers

The 0208 Comprehensive Waiver is Montana's primary Section 1915(c) Home and Community-Based Services (HCBS) program for individuals with intellectual and developmental disabilities. It funds community-based supports that allow eligible individuals to live outside of institutional settings — group homes, supported apartments, family homes, and semi-independent living arrangements.

Services funded under the waiver include:

• Residential habilitation — staffed group homes and host homes providing 24-hour support
• Day habilitation — structured daytime programming focused on community integration and skill development
• Supported employment — job coaching, workplace accommodations, and competitive integrated employment supports
• Personal care — assistance with activities of daily living (bathing, dressing, meal preparation, medication management)
• Respite care — temporary relief for primary caregivers
• Behavioral consultation — professional behavioral support planning
• Environmental modifications — home accessibility adaptations
• Specialized medical equipment — items not covered by standard Medicaid

The waiver is administered by the Montana Department of Public Health and Human Services (DPHHS) through the Behavioral Health and Developmental Disabilities Division (BHDD).

Eligibility Requirements

The 0208 waiver has two separate eligibility tracks that must both be satisfied:

Clinical eligibility is determined by DDP staff. The individual must have:

• An intellectual disability (documented IQ of approximately 70 or below) or a closely related neurological condition (autism, cerebral palsy, epilepsy, or similar) that originated before age 18
• Functional limitations in three or more major life activities (self-care, understanding and use of language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency)
• An expectation that the condition will continue indefinitely
• For autism specifically, Montana requires a Level 2 or Level 3 severity rating under the DSM-5 for both social communication and restrictive/repetitive behaviors

Financial eligibility is determined by the local Office of Public Assistance (OPA). Once a waiver slot is awarded, the individual is evaluated as a "household of one" — parental income and resources are completely disregarded. The individual must qualify for Medicaid, which is straightforward for most SSI recipients since Montana is a Section 1634 state with automatic Medicaid enrollment upon SSI approval.

The Waitlist Reality

The 0208 Waiver is not an entitlement program. Total enrollment is capped, historically between 2,500 and 3,000 active slots. As of the most recent data, approximately 2,550 individuals are receiving waiver services, with roughly 1,700 to 2,095 waiting for a slot.

The average wait time is approximately seven years from the date of waitlist placement.

Slots are assigned primarily on a chronological basis — whoever has waited longest gets the next opening. A small percentage of slots are reserved annually for acute crises or emergencies, such as a primary caregiver's death or hospitalization, or an immediate safety concern.

When a family is selected from the waitlist, the process moves quickly:

1. The individual and their case manager receive an official selection letter
2. The family has exactly 10 working days from the letter's date to respond and accept
3. Upon acceptance, the family has 90 days to select a provider agency or set up self-directed services

Failing to respond within the 10-day window can result in losing the slot and being returned to the waitlist.

Acuity-Based Rate Restructuring

The waiver's reimbursement system is undergoing a significant structural change. Historically, provider reimbursement was based on flat hourly or daily service rates regardless of the complexity of the individual's needs. Under the Behavioral Health System for Future Generations (BHSFG) initiative, Governor Gianforte authorized $100 million in funding for state fiscal years 2026 and 2027 to modernize the system.

A core component is the shift to acuity-based rates. The state allocated $950,000 in SFY26 and $7.5 million in SFY27 to reconfigure the reimbursement model. The new structure uses standardized assessments to align provider payments with the complexity of each individual's behavioral and medical needs.

The practical impact for families: providers caring for individuals with higher support needs should receive higher reimbursement, which — in theory — makes it easier to find agencies willing to serve individuals with complex behavioral profiles. One of the chronic problems in Montana's waiver system has been that flat rates made it financially unattractive for providers to take on high-acuity clients, leaving families waiting even after receiving a waiver slot because no provider would accept the case.

How to Start the Referral Process

The referral process begins with the DDP Central Office in Helena or a regional DDP office:

• Central Office (Helena): 406-444-2995
• Region 1 (Great Falls): covers north-central Montana
• Region 2 (Billings): covers eastern Montana
• Region 3 (Helena): covers southwest Montana
• Region 4 (Missoula): covers western Montana
• Region 5 (Glasgow): covers northeast Montana

For individuals over age 8, contact the central office or the nearest regional office directly. Submit the Eligibility Determination Checklist along with:

• Current psychological evaluation (within three years) documenting IQ and diagnosis
• Adaptive behavior assessment (the regional office will also schedule a standardized Vineland assessment)
• Educational records including IEP documentation and transition assessments
• Medical records establishing the diagnosis and age of onset

The eligibility determination is a DDP-internal process — it's separate from SSI, separate from Medicaid, and separate from any school district evaluation. Getting DDP operational eligibility doesn't trigger waiver services. It grants access to the waitlist.

Services Available While Waiting

The seven-year waitlist doesn't mean seven years without any support. While waiting for a 0208 slot, eligible individuals can access:

• Targeted Case Management (TCM) — available from age 16. A case manager helps coordinate services, navigate bureaucracy, and develop a person-centered plan. TCM is funded through standard Medicaid, not the waiver, so it doesn't require a waiver slot.
• Community First Choice (CFC) — a personal care program funded through Medicaid that provides hands-on assistance with daily living activities. CFC is available to anyone who meets the institutional level of care criteria, regardless of waiver status.

Neither program provides the full scope of residential or supported employment services that the 0208 waiver funds, but they can bridge critical gaps during the wait — particularly for families where the young adult lives at home and needs personal care support.

The Montana SSI at 18 & Adult Disability Benefits Guide maps the complete 0208 waiver application process alongside the SSI redetermination, Medicaid transition, and ABLE account setup — so families can track all four administrative queues from a single timeline rather than trying to coordinate three different agencies independently.

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