Montana 0208 Waiver Services — Residential, Day, and Employment Habilitation

What the 0208 Waiver Funds

The 0208 Comprehensive Waiver is Montana's primary Section 1915(c) Home and Community-Based Services program for individuals with intellectual and developmental disabilities. When a waiver slot opens — after what is currently an average seven-year wait — the individual gains access to a package of services designed to support community living as an alternative to institutional care.

Here is what those services actually include, and how they work in practice.

Residential Habilitation

Residential habilitation provides direct support to individuals in their homes — whether they live in a group home, a host (foster) family home, or their own apartment. Staff assist with daily living skills, behavior management, health monitoring, and community integration.

In Montana, residential habilitation comes in several forms:

Group homes (certified for 4–8 residents) provide 24-hour staffing with shared living spaces. The Montana DDP certifies group homes under specific codes, and the Optional State Supplement adds $94/month to the individual's SSI for residents in certified Code H or Code I homes.

Host home (foster care) arrangements place an individual with a trained family in a home-like setting. Host homes are certified by DDP and receive the Code J supplement ($52.75/month).

Supported living assists individuals in their own apartments or homes. Staff provide scheduled support — typically morning and evening routines, medication management, and community outings — rather than 24-hour coverage. The intensity varies based on the individual's service plan.

Semi-independent living is the least intensive tier, with periodic check-ins and community integration support. The Code K supplement is $26/month.

Day Services

Day habilitation programs provide structured activities during daytime hours, focusing on skill building, socialization, and community participation. Services may include:

• Pre-vocational skills training — punctuality, task completion, workplace behaviors
• Community integration activities — shopping, public transit training, recreation
• Social skills groups and therapeutic programming
• Life skills instruction — cooking, money management, personal hygiene

Day services are not babysitting. Montana's HCBS rules require that day programming be person-centered, tied to individual goals in the service plan, and delivered in integrated community settings when possible. The BHSFG (Behavioral Health System for Future Generations) initiative is pushing providers toward more community-based programming and away from facility-based day centers.

Supported Employment

The waiver funds supported employment services that help individuals find and maintain competitive, integrated employment. This includes:

• Job development and placement — identifying positions matched to the individual's skills and interests
• Job coaching — on-site support during the initial employment period, fading as the individual gains independence
• Long-term follow-along — periodic check-ins after the intensive coaching phase ends

Waiver-funded supported employment works alongside VRBS services. Typically, VRBS provides the initial job development and intensive training (funded through Vocational Rehabilitation dollars), and the waiver picks up long-term follow-along once the individual is stable in the position. Coordinating these two funding streams is the case manager's responsibility.

Targeted Case Management

Targeted Case Management (TCM) is available to DDP-eligible individuals regardless of whether they have a waiver slot. This is one of the few services accessible during the waitlist period.

Case managers provide:

• Assessment and service plan development — evaluating the individual's needs and creating a written plan
• Referral and coordination — connecting the individual to available services, scheduling appointments, and managing transitions between providers
• Monitoring — regular contact to ensure services are being delivered and needs are being met
• Crisis intervention coordination — acting as the central point of contact when emergencies arise

Once a waiver slot is assigned, the case manager becomes the individual's primary coordinator for all waiver-funded services.

Other Waiver Services

Beyond the major categories, the 0208 Waiver also covers:

• Environmental modifications — home modifications for accessibility (ramps, bathroom modifications, door widening)
• Specialized medical equipment — adaptive equipment beyond what Medicaid standard coverage provides
• Respite care — temporary relief for unpaid caregivers, providing trained staff to cover while the primary caregiver is away
• Transportation — non-medical transportation to and from waiver-funded services and community activities
• Personal emergency response systems — electronic monitoring devices for individuals living more independently
• Behavioral consultation — specialized behavioral support beyond what residential or day staff provide

The Acuity-Based Rate Transition

Montana is restructuring how it pays 0208 waiver providers. Under the old model, reimbursement was based on flat hourly rates regardless of the individual's needs. Governor Gianforte's BHSFG initiative allocated $950,000 in SFY26 and $7.5 million in SFY27 to transition to an acuity-based rate structure.

Under the new model, a standardized assessment determines the complexity of each individual's needs, and reimbursement rates are adjusted accordingly. Individuals with higher behavioral or medical acuity — including those with Level 2/3 autism, co-occurring psychiatric conditions, or complex medical needs — will generate higher reimbursement for their providers. The goal is to expand provider capacity, particularly in rural areas where providers have historically declined to serve high-acuity individuals because flat rates did not cover the true cost of care.

Finding the Right Provider

When a waiver slot opens, the individual has 10 working days to respond and 90 days to select a provider and complete enrollment. Montana maintains a provider directory through the DDP regional offices.

The five DDP regional offices — covering Great Falls, Billings, Helena, Missoula, and Glasgow — each maintain relationships with local providers and can help match individuals to available services. Your case manager should be your first point of contact, but the regional manager can intervene if provider availability is limited in your area.

The Montana SSI at 18 & Adult Benefits Guide maps out the full 0208 waiver enrollment process from DDP eligibility through provider selection, including the 10-day/90-day deadlines and regional office contacts.

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