Updated September 3, 2026. Quick answer: yes, through Big Sky Waiver (BSW). Medicaid does not pay the facility’s room and board either way; only the care and service component.
The same question in other states: Does Medicaid Pay for Assisted Living in Alabama?, Does Medicaid Pay for Assisted Living in Arizona? and Does Medicaid Pay for Assisted Living in Arkansas?
What Montana covers
| Waiver / state plan option | Big Sky Waiver (BSW) |
|---|---|
| Covers an assisted living setting? | Yes: The program provides assisted living services at multiple levels, serving individuals ages 65 or older and individuals with physical disabilities or other disabilities ages 0-64 years who meet a nursing facility level of care. |
| Room and board | Never covered by Medicaid, in Montana or any state; see below. |
The room-and-board split
Federal law is the floor every state builds on: “The Secretary may by waiver provide that a State plan approved under this subchapter may include as “medical assistance” under such plan payment for part or all of the cost of home or community-based services (other than room and board) approved by the Secretary” (42 U.S.C. §1396n(c)(1), Social Security Act §1915(c)). The words in parentheses do the work: whatever a state’s waiver pays for inside an assisted living community, it is not the rent, the meals, or the room itself. That portion stays the resident’s own to fund, out of income, savings, or a family contribution; the waiver only ever reaches the care and service layer on top of it. We did not find Montana’s own materials restating this point in the sources read this session; the federal rule above still governs.
The waitlist
Waitlisted: has an active waiting list : “Currently, the BSW Program has a waiting list.”
What you get to keep: the personal needs allowance
Not published in the materials reviewed this session. This is the amount of a waiver participant’s own income the state lets them keep for personal spending after the rest goes toward the cost of their care; it varies by state because each state sets its own figure inside the federal floor.
What this doesn’t answer
Montana confirms the Big Sky Waiver has an active waiting list but does not publish a current headcount or as-of date in the materials read this session. The personal needs allowance figure could not be independently confirmed from a Montana primary source this session: the state’s own policy-manual and member-guide PDFs did not yield extractable text, and no ARM rule stating the figure was located; a commonly cited $50/month secondary-source figure was not used as a citation.
Figures verified against the Montana DPHHS Big Sky Waiver page and one-sheet, the Big Sky Waiver 1915(c) application MT.0148.R07.00 (effective 07/01/24) and 42 U.S.C. §1396n(c)(1) (law.cornell.edu) on September 30, 2026; the Medicaid.gov factsheet wording on assisted living age groups, the waitlist headcount and the personal needs allowance were not re-checked.
Sources
Read September 3, 2026.
Same question, other states: Hawaii · Idaho.
Related: what assisted living actually costs · assisted living vs. staying home vs. a CCRC · why home care has a waitlist and a nursing home doesn’t.
General information drawn from each state’s own Medicaid agency and federal statute, not legal, tax or financial advice. Medicaid is administered state by state; waiver names, coverage decisions, waitlists and allowance amounts change by state budget and legislative action. This page cannot see your own state’s current caseload. 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.
Related: Montana’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.