Montana DPHHS In-Home Supports and Disability Services

The Services That Keep People Home

When families think about adult services after school, the conversation often starts with residential group homes or day programs. But for many individuals with disabilities in Montana, the goal is to live at home — either with family or in their own apartment — with enough support to make that work.

The Montana Department of Public Health and Human Services (DPHHS), through its Developmental Disabilities Program (DDP), funds several in-home and community-based services through the 0208 Comprehensive Waiver. These services are designed to support people in their own homes and communities rather than in institutional settings.

The challenge: these services require a waiver slot, and the 0208 waitlist averages approximately seven years. But understanding what's available — and planning for it — is essential during the transition years so families can build the right pipeline.

Personal Supports

Personal supports provide direct assistance with activities of daily living in the individual's home. A personal support worker helps with:

• Personal care — Bathing, grooming, dressing, toileting assistance
• Meal preparation — Planning meals, cooking, and feeding assistance where needed
• Medication management — Reminders, organizing, and administering prescribed medications
• Household tasks — Cleaning, laundry, and maintaining a safe living environment
• Community access — Assistance with grocery shopping, banking, and other errands

The level of support is individualized. Some people need a few hours a week. Others need daily assistance. The service plan is developed with the individual, their family, and their DDP case manager based on a functional needs assessment.

Companion Services

Companion services provide one-on-one support for community engagement and social participation. A companion worker accompanies the individual to:

• Community events and recreational activities
• Religious services, cultural events, and social gatherings
• Volunteer positions and community organizations
• Appointments and meetings

The distinction from personal supports is important: companion services focus on community participation and social connection, not personal care tasks. The companion is there to facilitate access and engagement — helping the individual navigate social situations, communicate with others, and participate meaningfully in community life.

For young adults transitioning out of school, companion services fill a social gap that school naturally provided. In school, social interaction is built into the day. After school, it requires intentional effort and often logistical support.

Respite Care

Respite care provides temporary relief for primary caregivers. A trained respite worker takes over care responsibilities for a defined period — a few hours, an overnight, or occasionally a weekend — so the primary caregiver can rest, attend to other responsibilities, or simply step away.

This service is critical for families where the parent or sibling is the primary caregiver. Caregiver burnout is well-documented, and the transition years are especially demanding — parents are simultaneously navigating school exits, agency applications, legal frameworks, and their own aging.

Respite can be delivered in the family home (the respite worker comes to the individual) or in a licensed respite facility. Montana's ARCH National Respite Network page lists state-specific resources and provider contacts.

Homemaker Services

Homemaker services cover household management tasks when the individual lives independently or semi-independently but needs support with maintaining their home:

• Cleaning, vacuuming, and organizing
• Laundry and ironing
• Meal planning and grocery shopping
• Basic home maintenance and safety checks

Homemaker services are distinct from personal supports because they focus on the home environment rather than direct personal care. An individual who can dress and bathe independently but struggles to maintain a clean apartment would benefit from homemaker services.

How These Services Connect to the IEP Transition Plan

Independent living goals in the IEP should map directly to the adult services the student will eventually need. This connection matters for two reasons:

1. Documentation for DDP service planning. When a waiver slot opens, the DDP case manager develops a service plan based on the individual's assessed needs. Years of IEP data showing what the student can and can't do independently — collected through independent living goals — provides a baseline that saves months of new assessments.

2. Skill building during the school years. The IEP transition plan should teach skills that reduce the level of in-home support the student will need as an adult. If the student learns to prepare simple meals through school-based community instruction, they may need fewer hours of personal support when they transition to adult services. The school years are the opportunity to build independence; adult services maintain it.

Accessing Services Before a Waiver Slot Opens

While the 0208 Waiver waitlist is long, some supports are available through other channels:

Targeted Case Management (TCM) — Available immediately upon DDP eligibility. A case manager coordinates services and advocates on the individual's behalf, even if waiver services haven't started yet.

Community First Choice (CFC) — Montana's CFC program provides personal care services under the Medicaid State Plan (not the waiver). CFC is available to individuals who meet an institutional level of care and are Medicaid-eligible. There is no waitlist for CFC, making it a crucial bridge service for families waiting for a waiver slot.

Montana independent living centers — Organizations like the Montana Independent Living Project and Summit Independent Living provide peer support, skills training, and advocacy services. These aren't Medicaid-funded services — they're community-based programs available regardless of waiver status.

Family-provided care — Many families provide in-home support themselves during the waiver wait. Montana does offer some self-directed service options through the waiver that allow family members to be paid as caregivers, but these are only available once a waiver slot opens.

The Montana IEP Transition to Adulthood Guide includes a service-by-service comparison chart covering all DPHHS in-home and community support options, eligibility requirements, and the relationship between IEP independent living goals and adult service categories — so families can plan the full arc from school exit through waiver activation.

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