Home care Medicaid rates in Montana are among the stronger ones in the country for the hours an aide spends with a client. Montana Medicaid pays $9.23 per 15 minutes for personal care on T1019 with modifier CG, or $36.92 an hour. That ranks 8th of 27 states with a comparable hourly rate and sits 21.0% above the national median of $30.52.
What sets Montana apart is that it pays companion care almost exactly like personal care. Most states pay aide-delivered companion hours well below agency personal care; Montana pays $37.56 an hour on S5135, slightly more than its personal care rate, and ranks 3rd in the country. Respite is the one line where Montana falls back to the middle of the pack. All rates are compiled from official state Medicaid publications and link to their source documents on the Montana Medicaid rates hub.
The current T1019 rate took effect on July 1, 2026, the same date as the state's July 1, 2026 fee schedule updates. Personal care in Montana is delivered under the Community First Choice and Personal Care Services program (1915(k) and state plan) and, for older and physically disabled adults, under the Big Sky Waiver. Both are paid fee-for-service from published schedules.
At 21.0% above the national median, the rate puts Montana agencies in a better position than providers in most of the West. It is still a long way from the top: Utah pays $84.84 an hour on S5125, and Oregon ($42.24), Iowa ($42.00), Delaware ($39.35) and Missouri ($39.00) round out the five highest. At the other end, Pennsylvania pays $19.48, Louisiana $19.08 and Texas $18.28. Montana sits in the upper third, closer to the top group than to the median.
Montana runs home care through two main routes, both fee-for-service:
- Community First Choice and Personal Care Services, under 1915(k) and the state plan. This is the main source of personal care hours for people who need hands-on help, and it is open to anyone who meets the eligibility and need criteria.
- The Big Sky Waiver, a 1915(c) waiver for elderly and physically disabled adults. It adds services such as companion care, homemaker, respite, adult day and self-direction support around personal care.
Separate waivers serve other populations: the Developmental Disabilities Program 0208 Comprehensive Waiver and the HCBS waiver for adults with severe disabling mental illness. Each publishes its own rates. For an agency, the program on the client's authorization decides which code and modifier apply and, therefore, which rate is paid.
The full Montana dataset holds all 141,671 current Montana Medicaid rates, one of the largest state schedules we track, including every waiver code and modifier.
Montana publishes rates for most home care lines we compare. Here is how each ranks:
| Service | Code | Montana rate | Rank | vs national median |
|---|---|---|---|---|
| Personal care (hour) | T1019 | $36.92 | 8 of 27 | +21.0% |
| Companion care (hour) | S5135 | $37.56 | 3 of 20 | +44.7% |
| Respite (hour) | S5150 | $24.80 | 22 of 38 | -2.0% |
| Respite (day) | H0045 | $198.42 | 22 of 34 | -18.1% |
| Financial management (month) | T2040 | $187.38 | 3 of 14 | +64.4% |
Companion care. At $9.39 per 15 minutes, S5135 in Montana trails only Vermont ($51.92) and South Dakota ($43.24). The national median is $25.96, and the bottom of the range is very low: Nebraska pays $11.33, Iowa $8.48 and Arkansas $6.72. For an agency, Montana is one of the few states where companion hours can be scheduled as a stand-alone service rather than an add-on.
Respite. Hourly respite on S5150 pays $6.20 per 15 minutes, or $24.80 an hour, just under the $25.30 median. Daily respite on H0045 with modifier HD pays $198.42, below the $242.21 median and far from Minnesota's $938.09.
Self-direction. Montana pays $187.38 a month for financial management services on T2040, behind only California ($265.00) and New York ($260.24). That is a meaningful fee for the organizations that handle payroll for self-directed workers.
Adult day. Montana bills adult day on S5100 with modifier HD at $3.25 per 15 minutes, or $13.00 an hour. Because most states pay adult day per day, Montana's rate is not ranked against the $68.67 national daily median.
The median wage for home health and personal care aides in Montana was $17.61 an hour in May 2025, slightly above the US median of $17.21. Registered nurses, who supervise aides in many programs, earned a median of $41.00, below the national $46.90.
Set against the published rates, the picture splits by service:
- Personal care. The aide wage takes 67.8% of the $36.92 rate, leaving a margin of $11.89 an hour after loaded wages.
- Companion care. The wage takes 66.6% of the $37.56 rate, leaving $12.53 an hour.
- Hourly respite. The wage takes 100.9% of the $24.80 rate, leaving a small negative margin after loaded wages.
That last figure matters for agencies that staff respite with the same aides who deliver personal care. Every respite hour is paid at a rate that does not cover a median-wage aide's loaded cost, so respite works only as part of a mix weighted toward personal care and companion hours.
Montana's personal care rates are not the whole payment. Two state plan amendments, both approved by CMS and effective July 1, 2025, updated the reimbursement sections of the state's personal care programs:
- MT SPA 25-0014 amended Community First Choice to update the dates and amounts of the direct care wage and health care for health care worker add-on payments.
- MT SPA 25-0015 made the same update for Personal Care Services.
For an agency, the add-ons matter in two ways. They raise total revenue per hour above the published base rate, and they usually come with expectations about how the money is used, such as passing it to direct care wages or funding worker health coverage. Agencies should track add-on revenue separately and be ready to show where it went.
Montana attaches prior authorization rules to most home care codes. Adult day on S5100 carries the most, with 18 rules, and personal care on T1019 has 14. Daily respite on H0045 has 5, while S5125, S5130 and S5135 have 3 each, and S5131, S5150 and T1005 have 2 each. None of these codes carries a unit limit in our data.
In practice, that means authorization management is part of the cost of delivering even companion and homemaker hours. Agencies should match each authorized service to the exact code and modifier on the schedule, since T1019 with modifier CG is the rate that carries the current personal care price.
Several recent notices touch home care billing:
- July 1, 2026 Fee Schedule Updates, effective July 1, 2026. This is the date the current T1019 rate took effect.
- MAR Notice No. 2026-127.1, a proposal to update Medicaid and non-Medicaid provider rates and fee schedules, effective July 1, 2026, with a listed change of 3.39%.
- Montana Medicaid Big Sky Waiver (BSW) Amendment, posted December 23, 2025, with a proposed effective date of June 1, 2026. The Big Sky Waiver covers elderly and physically disabled adults.
Most of the other home care rates on file, including companion, respite and self-direction, have been in effect since July 1, 2025.
Montana pays home care fee-for-service. Its home care programs, including the Big Sky Waiver and the Community First Choice and Personal Care Services program, are paid from state-published schedules rather than negotiated plan rates. The 17 plans and arrangements on file are mostly primary care programs, such as Primary Care Montana, transportation brokers and tribal health programs; none of them prices home care. See the Montana managed care page for the plans and rules on file.
For an agency, this means the published schedule and the add-on payments are the whole story. There is no plan contract to negotiate, and a rate change reaches every provider on the same date.
Montana is a high-paying state for the services an aide delivers directly, a middle-of-the-pack state for respite, and one of the strongest payers for self-direction administration. Compare it with neighboring Wyoming, with Utah at the top of the personal care ranking, or with Texas at the bottom. Across the northern border states, North Dakota pays slightly more for personal care and South Dakota more for companion care.
Build around personal care and companion hours
With margins of $11.89 on personal care and $12.53 on companion care after loaded wages, those two lines carry the agency. Respite, at a small negative margin, is best offered to existing clients by aides already scheduled nearby.
Plan for the July cycle
Montana's fee schedules update on July 1, and MAR notices such as 2026-127.1 propose the rate changes that follow. Read each proposal when it is published, since the listed change shows the direction of the coming year's rates.
Account for rural travel
Montana's distances make travel time a real cost. A strong hourly rate can be eroded by long drives between visits, so route planning and clustering clients by area protect the margin.
Rates on this page are compiled from official state Medicaid publications, including Montana fee schedules, MAR notices and state plan amendments named above. Each rate links to its source document on the Montana Medicaid rates hub. Hourly figures are converted from 15-minute units and ranked against every state with a comparable rate; wage figures are state and US medians for May 2025.
The national home care overview covers every state, our methodology explains how hourly conversions and ranks are calculated, and the pricing page describes access to the full Montana dataset, with history since 2007.