Montana Community First Choice (CFC) Personal Care — Medicaid Without the 0208 Waitlist

What Community First Choice Is and Why It Matters

The 0208 Comprehensive Waiver is the primary funding vehicle for community-based developmental disability services in Montana — but its waitlist averages seven years, with roughly 2,095 people currently waiting for one of approximately 2,500–3,000 slots. For families who just completed the DDP eligibility process and landed on that list, seven years of waiting with no services is not a realistic option.

Community First Choice (CFC) is Montana's answer to that gap. It is a Medicaid state plan option — not a waiver — that provides personal care and attendant services to individuals who meet an institutional level of care. Because CFC is a state plan benefit rather than a waiver, it has no enrollment cap and no waitlist. If you qualify for Medicaid and meet the clinical criteria, you are entitled to CFC services.

Who Qualifies

CFC eligibility requires two things:

1. Active Montana Medicaid coverage. This can come through any qualifying pathway — automatic 1634 enrollment via SSI, HELP Act Medicaid Expansion, traditional Aged/Blind/Disabled Medicaid, or a Medically Needy spend-down determination.

2. Institutional level of care. The individual must require the type and intensity of care that would otherwise be provided in a nursing facility or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). This is the same clinical threshold used for 0208 waiver eligibility, so many individuals who are DDP-eligible and on the 0208 waitlist already meet this standard.

The clinical assessment is conducted by the state or its designee. If your young adult has already completed the DDP eligibility determination — including the Vineland Adaptive Behavior assessment — much of the documentation needed for the CFC level-of-care determination is already in hand.

What Services CFC Covers

CFC provides personal assistance services that help individuals with activities of daily living and instrumental activities of daily living. This includes:

• Personal care: Bathing, dressing, grooming, toileting, eating assistance, mobility support, and transferring
• Attendant services: Supervision and cueing for individuals who can physically perform tasks but need prompting or monitoring due to cognitive or behavioral limitations
• Health-related tasks: Medication management, wound care, and other health maintenance tasks that can be safely delegated to a trained personal care worker
• Self-directed option: Montana's CFC program allows participants to self-direct their services — hiring, training, and managing their own personal care workers rather than going through an agency. Family members (other than a legally responsible spouse or parent of a minor) can serve as paid caregivers under self-direction.

CFC does not cover the broader array of services available under the 0208 waiver — residential habilitation, day services, supported employment, specialized medical equipment, or environmental modifications. It is specifically personal care and attendant support. Think of it as the immediate bridge that keeps your family member safe and supported at home while you wait for the full waiver package.

How CFC Fits With the 0208 Waitlist

CFC and the 0208 waiver are not mutually exclusive, but they do interact:

• While on the 0208 waitlist, an eligible individual can receive CFC services through Medicaid
• When a 0208 slot opens and the individual enrolls in waiver services, personal care is typically provided through the waiver rather than through CFC — the waiver becomes the primary funding source
• Receiving CFC services does not affect your position on the 0208 waitlist

In addition to CFC, individuals on the 0208 waitlist can also access Targeted Case Management (TCM) through DDP. TCM services — coordination, referral, monitoring, and planning — become available once DDP operational eligibility is established, even before a waiver slot is assigned. TCM is the other major service available during the waitlist period.

How to Access CFC in Montana

The referral pathway depends on how the individual enters the Medicaid system:

1. If the individual is already on Medicaid and has DDP eligibility: Contact the DDP regional office and request a CFC level-of-care assessment. The DDP Quality Improvement Specialist who conducted the Vineland assessment can direct you to the appropriate referral.

2. If the individual is on Medicaid but has not completed DDP eligibility: Contact the local Office of Public Assistance and request a referral for a CFC level-of-care assessment. You do not need DDP eligibility to access CFC — you need Medicaid and an institutional level of care.

3. If the individual is not yet on Medicaid: Start with the Medicaid application through apply.mt.gov. For most young adults with disabilities, SSI approval triggers automatic Medicaid under Section 1634, but HELP Act Expansion and ABD pathways are also available.

Once the level-of-care assessment confirms eligibility, the individual selects a provider agency or opts into self-directed services. Montana's provider network for CFC/PAS services includes agencies like Alpenglow Homecare in Missoula and Great Falls, along with statewide self-direction fiscal management services.

The Montana SSI at 18 & Adult Benefits Guide maps out all four benefit tracks — SSI, Medicaid, DDP, and the 0208 waiver — showing exactly when CFC and TCM become available and how to access them while your waitlist position matures.

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