Updated September 3, 2026. Quick answer: yes, through Self-Directed Community First Choice Services / Personal Assistance Services (SD-CFC/PAS). Most adult family members can be hired and paid to provide the care. A spouse can also be the paid caregiver.
How Montana pays a family caregiver
| Program | Self-Directed Community First Choice Services / Personal Assistance Services (SD-CFC/PAS) |
|---|---|
| Can a family member be paid? | Yes. “Payment to legally responsible persons for CFCS is available when an individual requires extraordinary care as demonstrated by a state-approved functional assessment. … A legally responsible person may also be paid for services that are not considered extraordinary when an individual is unable to access non-legally responsible personal care providers because of geographic, cultural, or other factors limiting availability of care providers.” |
| Can a spouse be paid? | Yes. “A legally responsible individual is any person who has a duty under state law to care for another person. For the purpose of the Severe and Disabling Mental Illness, Home and Community Based Services waiver, a legally responsible individual is a spouse or a legal guardian. … The following services may be provided by a legally responsible individual: … (b) personal assistance …” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
$7.91 per 15-minute unit (~$31.64/hour), effective 7/1/2025. “T1019 U9 CG, TS Self-Directed Personal Assistance Services – 15 minutes 7/1/2025 Fee Sched $7.91”
How it works
A member is referred to the state’s quality health contractor for a home visit and level-of-care assessment; for self-direction, the member selects one enrolled Self-Directed CFC/PAS provider agency, which formally employs the personal care attendant (including a hired family member) for payroll/billing purposes, while the member actually hires, trains, and directs that worker.
What this doesn’t answer
The exact CFC-specific rule subsection confirming the word “spouse” (as distinct from the parallel SDMI-waiver provision independently verified) was seen only via a third-party mirror, not reopened on an official mt.gov rule page. Whether the published $7.91/15-min rate is passed through to the family worker in full or reduced by an administrative fee was not addressed by any primary source found.
Sources
- DPHHS Notice of Adoption, MAR 37-1065: ARM 37.40.1002(12) payment to legally responsible persons for CFCS
- DPHHS SDMI HCBS Waiver Manual 140: Payment Made to Legally Responsible Individuals
- Montana Healthcare Programs Fee Schedule, Community First Choice Services, effective 7/1/2025
Read September 3, 2026.
Same question, other states: Alaska · Arizona.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.