Montana Community First Choice Services and Personal Care Services: Montana 2026 Guide
Montana Medicaid offers in-home help with daily activities through two related state plan programs: Community First Choice Services (CFCS) and Personal Care Services (PCS). DPHHS renamed these programs, formerly Community First Choice and Personal Assistance Services (CFC/PAS), with the new names fully in use by the end of 2025. Both pay for a trained worker to help with bathing, dressing, eating, toileting, moving around and related household tasks. CFCS is for people who meet a nursing home level of care; PCS serves people with less need. Both are administered by the Senior and Long-Term Care Division of DPHHS.
This page explains who can get CFCS and PCS in 2026, what kind of help it pays for, how to request it, and how it compares with waivers and nursing home Medicaid. For the full statewide rules on income, assets, spouses and the look-back, see our Montana Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What CFCS and PCS is
Community First Choice is a federal option, known as 1915(k), that lets a state offer attendant care as a regular Medicaid benefit rather than as a capped waiver. DPHHS describes both CFCS and PCS as entitlement programs. Members choose Agency-Based CFCS/PCS, where an agency manages the care, or Self-Direct CFCS/PCS, where the member or a personal representative hires, trains and manages the personal care attendants. Self-direction needs authorization from a health care professional and lets the attendant help with four skilled tasks: a bowel program, urinary system management, medication assistance and wound care. Because CFCS is an entitlement, it does not have the enrollment cap that the Big Sky Waiver has, though the hours a person receives depend on an assessment.
The core of CFCS and PCS is hands-on help with daily activities: bathing, dressing, eating, toileting and getting around, plus household tasks tied to that care. Because it is part of Montana’s regular Medicaid plan, everyone who meets the rules can receive it. The trade-off is that state plan services are narrower than waiver services, and hours are set by an assessment.
Who qualifies in 2026
Montana’s basic requirements are that a person must:
- be enrolled in full Montana Medicaid;
- live in their own home or a family home, not in a nursing facility or hospital;
- need hands-on help with activities of daily living, as shown by a nurse assessment;
- have a health condition that limits activities of daily living and take part in the screening process;
- for CFCS, also meet a nursing home level of care (PCS does not require it); and
- have a physician or other practitioner confirm the need for services, where required.
Who qualifies financially. Applicants need regular Montana Medicaid, whose income limit for older adults is often below the long-term care limit. Some people who would qualify for nursing home care therefore qualify for state plan services only through a spend-down, or not at all.
Montana’s 2026 long-term care Medicaid numbers, from our state guide:
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | No fixed cap for nursing home care (income must be no more than the monthly cost of care) |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 |
| Spouse at home: resource allowance (CSRA) | Greater of half the couple’s resources (up to $162,660) or $32,532 |
| Spouse at home: monthly income allowance | $2,705 (basic needs) / maximum $4,067 |
| Personal needs allowance (nursing home) | $50 a month |
| Look-back period | 60 months (5 years) |
Couples. State plan programs often count a married couple’s resources together, without the full spousal impoverishment protections.
Services CFCS and PCS can cover
The assessment sets the hours, and the help can include:
- bathing, dressing, grooming and toileting
- eating
- medication assistance
- ambulation and exercising
- medical escort
- for PCS, limited grocery shopping, housekeeping and laundry
- for CFCS, skill acquisition, community integration, correspondence help and removal of yard hazards that block safe access to the home
- for CFCS, personal emergency response systems
- in self-direction only, four skilled tasks authorized by a health care professional
CFCS and PCS do not pay for lawn care (other than removing yard hazards), household repairs or modifications, major cleaning, shopping for non-essential items, escort to non-medical services, pet care or general transportation. Some of these can be covered by the Big Sky Waiver, depending on need.
Limits. CFCS and PCS is not 24-hour care and does not cover room and board or general housekeeping; skilled nursing and therapy are separate Medicaid services. People needing more help often move on to a waiver or managed long-term care.
How to apply for CFCS and PCS
The usual path is:
- Make sure the person is on full Montana Medicaid. If not, apply through the state’s benefits website or the county Office of Public Assistance.
- Request a referral from a CFCS or PCS provider agency, the person’s doctor, or the Senior and Long-Term Care Division for an assessment.
- A nurse assesses needs at home and decides the number of hours.
- Choose agency-based services or self-direction. In self-direction, the member or a representative hires the attendant and the fiscal agent handles payroll.
- Services start under a written service plan, and needs are reassessed periodically.
Tips for the paperwork. Keep a folder of copies, and log every call with the date and name. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Memory problems, falls and the need for supervision all count, even when the person can still do some tasks alone. If the answer is no, the written notice explains how to request a fair hearing and the deadline.
Waiting lists and timing
Because CFCS and PCS are entitlements, there is no enrollment waiting list. Delays can still come from the Medicaid application, the assessment, and finding an available worker, which is often the hardest step in rural Montana.
Because it is an entitlement, state plan personal care should not have an enrollment waiting list. Even so, the application, the assessment and finding an aide can each add weeks.
How it relates to nursing home Medicaid
People who need more than CFCS or PCS can offer may qualify for the Big Sky Waiver, which adds services such as adult day health, assisted living, home changes and respite, though it has a waiting list. Some people receive CFCS while waiting for a waiver slot.
CFCS and PCS reaches people earlier, often before they would qualify for nursing home care. It is not meant to replace a nursing home for someone who needs care around the clock. If needs grow, the next steps are usually a waiver, managed care or nursing home care. Nursing home Medicaid uses the special long-term care income limit and spousal protections, so a person over the limit for state plan care may still qualify for a nursing home.
Planning around CFCS and PCS
Families usually look into CFCS and PCS after a health event or when a caregiver is stretched thin. A bit of preparation helps. Start by writing down what help is needed each day, who provides it now, and what would happen if that person were unavailable for a week. That list supports the assessment and shows where paid help would make the biggest difference.
Paperwork usually includes bank statements, income letters, insurance cards, and proof of identity and residence in Montana. Holding on to five years of records now saves time if fuller long-term care Medicaid is needed later. A durable power of attorney and health care directive, signed while the person can still make decisions, let a family member handle applications and appeals without court involvement.
Needs rarely stay the same, so revisit the arrangement regularly and request a reassessment when things change. Families who keep notes on changes, such as new diagnoses, falls or hospital visits, find later reviews and applications go more smoothly.
Tips for families
Before the assessment, list every task the person needs help with, how often, and how long it takes. If a relative wants to be the paid worker, check the program’s rules early, since rules on paying relatives, training and background checks vary. Low hours can be appealed through a fair hearing.
Working with a Certified Medicaid Planner is often the fastest way through CFCS and PCS. A planner who handles Montana cases regularly can spot eligibility problems before Montana DPHHS does, organize the records and help plan around any wait. Fees vary: roughly $500 to $6,000 for application help, $2,500 to $15,000 or more for full planning, and $150 to $600 an hour for advice.
Related pages
- Montana Medicaid guide
- Montana Big Sky Waiver
- In-home care and Medicaid
- Activities of daily living
- Consumer-directed care
- Paid family caregivers
- HCBS waivers explained
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.