If you or a family member is on Montana Medicaid and needs a ramp, grab bars, or other accessibility work, the state's Big Sky Waiver (BSW) may help pay for it. The program is run by the Montana Department of Public Health and Human Services (DPHHS), through its Senior and Long Term Care Division, Community Services Bureau. The waiver covers a service called Environmental Accessibility Adaptations. Here is how the program works and how to apply.
What Montana offers#
The Big Sky Waiver is a home and community-based services (HCBS) waiver, authorized under Section 1915(c) of the Social Security Act. It serves people age 65 or older, and people of any age with physical or chronic disabilities, who meet a nursing-home level of care.
The waiver covers a service called Environmental Accessibility Adaptations, sometimes called Environmental Modifications. These are physical changes to the home that help the person function with greater independence. Examples include an outside ramp so the person can safely enter the home, and safety devices such as railings and grab bars.
A few rules apply. The modification must be medically necessary and related to the member's diagnosis. It must be written into the member's service plan. It must be the most cost-effective option. It cannot be general housing maintenance. Coverage is also limited to one ramp per residence. The Big Sky Waiver covers vehicle modifications too.
One helpful detail: Environmental Accessibility Adaptations sit alongside a separate service called Specialized Medical Equipment. Your care team decides which category a request falls into. You do not need to pick the category yourself. Just describe what you need.
Amounts and eligibility#
Montana does not publish a per-modification or annual dollar cap for Environmental Accessibility Adaptations. No figure appears on the DPHHS program page, in the policy manual, or in the state's HCBS information sheet. The amount approved depends on your individual service plan. Anyone quoting a fixed statewide dollar limit for this service is not using an official DPHHS source.
For financial eligibility, you must be financially eligible for Montana Medicaid. The Office of Public Assistance decides whether you qualify, and you can reach it at 1-888-706-1535. Montana sets its own income rules for this waiver, so do not assume the limit matches figures you may have seen for other states. Only the Office of Public Assistance can confirm whether your income and resources qualify. Nothing here is a guarantee of eligibility.
How to apply in Montana#
Applying takes two steps.
First, apply for Montana Medicaid. You can apply online at apply.mt.gov, by phone through the Office of Public Assistance at 1-888-706-1535, or by emailing hhssspapplicationcustomersupport@mt.gov to request a paper application. Your county Office of Public Assistance can help with Medicaid eligibility.
Second, request a waiver screening from Mountain Pacific Quality Health at (406) 443-4020 or (800) 219-7035, an outside quality-improvement organization that handles waiver screening instead of a state office. You apply for Medicaid through DPHHS and the Office of Public Assistance, then get screened separately by Mountain Pacific. Expect that handoff.
Once you are enrolled, your services are coordinated by a Case Management Team (CMT), a nurse plus a social worker. The team builds your service plan, and that plan is what authorizes any modifications. Montana does not run this waiver through managed care.
Be prepared for a wait. The DPHHS program page states plainly that the Big Sky Waiver currently has a waiting list. No official count or wait-time figure is published. To ask about current status, contact Mountain Pacific Quality Health using the numbers above.
If you need help finding local aging services, Montana Aging Services and the Area Agencies on Aging network operate through the DPHHS Senior and Long Term Care Division. The federal Eldercare Locator (eldercare.acl.gov, 1-800-677-1116) is a fallback.
How it stacks with federal programs#
If the person needing modifications is a veteran, grants from the U.S. Department of Veterans Affairs (VA) may help fund a larger project alongside Montana Medicaid. See our VA home modification grants guide for details.
Original Medicare does not cover structural home modifications. Some Medicare Advantage plans, also called Part C, cover extras like grab bars or ramps as a supplemental benefit. Coverage is plan-specific, though, with no standard dollar amount. Call your plan directly to ask what it covers.
Finding a provider who knows this program: Not every contractor has handled BSW paperwork. Adapta Home USA verifies providers' Medicaid Waiver Billing experience, so you can filter for pros who have done this before in Montana. Find Home Modifications & Remodeling providers in Montana with Medicaid Waiver Billing experience →
For the bigger picture on combining programs, see our national Medicaid HCBS waiver guide and our full guide to paying for home modifications.
FAQ#
Does Montana Medicaid pay for home modifications like wheelchair ramps or grab bars?#
Yes. The Big Sky Waiver covers a service called Environmental Accessibility Adaptations, which can include an outside ramp and safety devices such as railings and grab bars for people who qualify for the waiver.
What is the Big Sky Waiver and who is eligible?#
It is Montana's home and community-based services waiver. It serves people age 65 or older, and people of any age with physical or chronic disabilities, who meet a nursing-home level of care.
Is there a waitlist for Montana's Big Sky Waiver?#
Yes. The DPHHS program page states that the Big Sky Waiver currently has a waiting list. No official count or wait time is published. Contact Mountain Pacific Quality Health at (406) 443-4020 or (800) 219-7035 to ask about current status.
How do I apply for the Big Sky Waiver in Montana?#
Apply in two steps. First, apply for Montana Medicaid online at apply.mt.gov, by phone through the Office of Public Assistance at 1-888-706-1535, or by email for a paper application. Second, request a waiver screening from Mountain Pacific Quality Health at (406) 443-4020 or (800) 219-7035.
Find a verified provider near you#
Adapta Home USA's directory lets you search Home Modifications & Remodeling providers in Montana and filter for Medicaid Waiver Billing experience. Our wheelchair ramp cost guide can help you budget while you wait to hear back.
This article is for general educational purposes only and does not constitute medical, legal, or financial advice. Consult a qualified professional about your specific situation.
Program amounts, eligibility rules, and application procedures change. Figures on this page were verified against official government sources on the date shown, but you should confirm current details at VA.gov or with the administering agency before making decisions. Adapta Home USA is not affiliated with the U.S. Department of Veterans Affairs or any government agency.