Written by a parent, not a doctor. Nothing here is medical advice.

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Montana program

Medicaid that counts only your child’s income (Big Sky Waiver)

A Medicaid route that leaves parents’ income out when a child needs nursing-facility-level care (Big Sky Waiver).

What it is

A Medicaid route that leaves parents’ income out when a child needs nursing-facility-level care (Big Sky Waiver).

Big Sky may add home services even when your child already has Medicaid. It also offers an income route for some children. A diagnosis alone does not qualify, and Montana reports a waiting list.

Eligibility rules
  • The waiver serves all ages statewide.
  • A screening must establish nursing-facility-level care.
  • Once your child is on the waiver, only the child's own income and savings count.
  • Big Sky requires a nursing-home level-of-care assessment, an available waiver opening and a separate Medicaid financial decision. After the child is approved for this waiver route, parents’ income and resources are not deemed to the child. Montana reports a waiting list; Mountain Pacific can discuss screening at 1-800-219-7035. The benefits office must identify the child’s eligibility category, countable resources and any monthly amount the child must pay.
What you get
  • Full Medicaid and approved home services when your child qualifies and a place opens.
What it covers
  • Big Sky has a limited number of waiver openings and Montana reports a waiting list.
  • Places are prioritized by need.
  • If your child has income of their own, such as SSI or child support, part of it can be owed each month; the approval letter says whether anything is owed.
If you decide to apply
  1. Your social worker can help you talk with the Big Sky screening team at 1-800-219-7035.
  2. Bring medical records and a daily account of the help your child needs.

Big Sky Waiver screening: 1-800-219-7035 · Official page ↗

After you ask
  • The referral team can explain waiting-list status and help available while waiting.
Good to know

Ordinary Medicaid home nursing has a separate review. A waiver waiting list does not replace it.

Other details
  • The developmental-disability waiver has different eligibility and is not a leukemia route by diagnosis.
Official sources
Ask your social worker

“Could our child’s care needs fit Big Sky Waiver? What would the wait and responsibilities mean, and could you help arrange a screening if useful?”

Why I’m asking: I want to understand whether a Big Sky assessment could open needed services or another Medicaid route.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for the screening by name and keep asking where the waiting list stands.

Your social worker

The social worker sends the medical records and the care description that the level-of-care form needs.

The care team

Writes what your child cannot do without help, day by day: that is what the screening form asks.

Who decides
The state health department decides, after a screening by its review organisation.
Ask the agency
“I would like a Big Sky Waiver screening for my child, who is in cancer treatment. Where does the waiting list stand today, and does Montana have a Katie Beckett category as well?”

How to apply

First step: Your social worker can help you talk with the Big Sky screening team at 1-800-219-7035.

  1. Your social worker can help you talk with the Big Sky screening team at 1-800-219-7035.
  2. If you decide to pursue this option, your social worker can help review the care assessment, child’s finances and current waiting list.
  3. If you decide to pursue this option, your social worker can help review the care assessment, child’s finances and current waiting list.

Official application / program page ↗

Where it starts: Call the referral line and ask for a Big Sky Waiver screening. Ask at the same time where the waiting list stands.

What to gather

  • The oncology team’s description of daily care needs
  • Your child’s own income and accounts, if any
  • Recent hospital records

How long: No timeline is published. The screening comes first, then the list.

What a yes looks like

A level-of-care approval and a place on the waiver, which opens full Montana Medicaid with only your child’s income counted.

What a no looks like, and the next move

A no on level of care, or a place on the waiting list. Ask for the screening result in writing, ask about the spend-down route, and appeal by the date on the notice.

Watch out

  • A waiting list is running and the state publishes no count or wait, so ask where it stands.
  • The test is a nursing-home level of care, not the diagnosis.
  • The developmental-disability waiver is a separate programme and is not a route for leukemia.

Dates that change this

2026-09-10: Whether Montana elects the Katie Beckett option could not be verified either way: the state plan page returned an error. Ask the Office of Public Assistance whether a Katie Beckett or TEFRA category exists for your child rather than assuming there is none. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full Montana Medicaid and approved home services require a care assessment, a waiver opening and a separate financial decision. Approved waiver rules can stop counting parents’ finances.

  • $2,783/year — Annual unduplicated participants across all ages (waiver appendix B-3)

Covers: Full Montana Medicaid once enrolled · Personal assistance at home, including approved extraordinary care by a qualified parent · Case management and community services

Legal protection: Parent income and resource deeming is waived; only the applicant’s own income is tested

What it costs the family: The office calculates any spend-down or patient payment under the child’s applicable Medicaid category and deductions; the written notice gives the amount and dates.

The eligibility facts, as published

Income
the child’s own income only; parent-to-child deeming is waived (ABD 900, ABD 901.1)
Level of care
meets the requirements for nursing-facility placement, decided on the Screening Determination form
Age
all ages
Geography
statewide
Priority
need-based prioritisation, not a diagnosis entitlement

Decisions this site cannot make: Screening Determination for level of care, done by the state’s review organisation

Expect friction on: An active waiting list with no published count or wait · Entry prioritised by need, not by diagnosis

The trap: High income does not establish waiver eligibility. The child needs a nursing-facility-level care assessment, an opening and a separate financial decision. The screening team confirms the current waiting list.

Where I read this

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