The Montana Medicaid answer, verified
Yes - Montana Medicaid's Big Sky Waiver (BSW) covers 'Adult Residential' residential-habilitation services delivered in a licensed assisted living facility (personal care, homemaker services, meals, medication oversight, social/recreational activities and 24-hour on-site staff), but room and board is excluded: the BSW policy manual states 'Medicaid reimbursement for room and board is prohibited.' The waiver is not an entitlement and currently has a waiting list. Here is what that means in practice for Boulder families - eligibility, what waivers cover, and what stays out of pocket.
Assisted living near Boulder compares against a national median of $6,200 a month - and Montana's own median of $6,075, ranked #29 of 50 states.
A semi-private nursing home room runs $9,581 a month at the 2025 national median - the number Boulder families weighing skilled care start from.
In-home care averages $35 an hour nationally - about $80,080 a year at 44 hours a week for Boulder households.
The honest Montana answer, verified against official sources: Yes - Montana Medicaid's Big Sky Waiver (BSW) covers 'Adult Residential' residential-habilitation services delivered in a licensed assisted living facility (personal care, homemaker services, meals, medication oversight, social/recreational activities and 24-hour on-site staff), but room and board is excluded: the BSW policy manual states 'Medicaid reimbursement for room and board is prohibited.' The waiver is not an entitlement and currently has a waiting list. Eligibility is strict - income and asset limits apply, and there is typically a five-year look-back on gifts and transfers - so families planning a Medicaid path should talk to an elder law attorney early.
Yes - Montana Medicaid's Big Sky Waiver (BSW) covers 'Adult Residential' residential-habilitation services delivered in a licensed assisted living facility (personal care, homemaker services, meals, medication oversight, social/recreational activities and 24-hour on-site staff), but room and board is excluded: the BSW policy manual states 'Medicaid reimbursement for room and board is prohibited.' The waiver is not an entitlement and currently has a waiting list. Whatever your state covers, one rule is nearly universal: waivers pay for care services, and the family still handles living costs - so a Medicaid path still needs a budget.
The 2026 numbers
| Care type | 2025 national median | What it covers |
|---|---|---|
| In-home care | $35/hour | Non-medical help at home - meals, bathing, companionship |
| Adult day care | $95/day | Daytime supervision and activities, evenings at home |
| Assisted living | $6,200/month | Housing plus daily-living help; care-level fees extra |
| Memory care | typically 20-40% above assisted living | Secured dementia care with higher staffing |
| Nursing home (semi-private) | $9,581/month | 24/7 skilled medical care |
| Nursing home (private room) | $355/day | Same care, private room |
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Montana: Medicaid, prices and the inspection file
| Question | Montana answer |
|---|---|
| Medicaid & assisted living | Yes - Montana Medicaid's Big Sky Waiver (BSW) covers 'Adult Residential' residential-habilitation services delivered in a licensed assisted living facility (personal care, homemaker services, meals, medication oversight, social/recreational activities and 24-hour on-site staff), but room and board is excluded: the BSW policy manual states 'Medicaid reimbursement for room and board is prohibited.' The waiver is not an entitlement and currently has a waiting list. |
| State median, assisted living | $6,075/month (#29 of 50 states) |
| Licensing & inspection records | Montana Department of Public Health and Human Services (DPHHS), Office of Inspector General (OIG), Licensure Bureau |
Montana licenses assisted living by acuity category A/B/C: a Category 'C' facility is one with a secure or locked unit reserved for residents with severe cognitive impairment (defined as being unable to recognize danger, self-evacuate, summon assistance, express need or make basic care decisions), so the license letter tells a family whether the building can legally hold a memory-care resident.
This guide is research, not advice: an independent summary of published costs and state rules. It is not a care provider, placement agency, law firm or financial advisor - care and Medicaid decisions deserve professional advice for your family's situation.
What this means for Boulder families
A fair comparison prices the whole picture: home care hours plus home maintenance, transport, and the family hours nobody bills. Communities bundle those in - which is why the sticker comparison understates what assisted living replaces.
This guide is research, not advice: an independent summary of published costs and state rules. It is not a care provider, placement agency, law firm or financial advisor - care and Medicaid decisions deserve professional advice for your family's situation.
Common questions
How much does in-home care cost?
About $35 an hour at the 2025 national median - roughly $80,000 a year at 44 hours a week. Since the 2025 survey, non-medical caregivers are tracked as a single category, so quotes for 'homemaker' versus 'home health aide' services should no longer differ much for non-medical help.
How much does assisted living cost?
The U.S. median is $6,200 a month ($74,400 a year) per the 2025 CareScout Cost of Care Survey - before care-level fees, which add hundreds more at higher need levels. State medians vary widely; this guide shows your state's number and rank on every page.
Does long-term care insurance actually help?
If your parent bought a policy years ago, yes - claim it early, as most policies have elimination periods before benefits start. Buying new coverage in one's 80s is generally not realistic. Check old files: policies bought decades ago are routinely forgotten and unclaimed.
Should my parent stay home with help or move to assisted living?
Run the hours math first: in-home care at about $35 an hour serves people who need help, not round-the-clock supervision. Below about 30-40 hours a week, home usually costs less; past that - or when safety needs someone always present - assisted living's $6,200 median often buys more coverage. The right answer follows the care needs, not the buildings.
What fees do communities add on top of rent?
Care-level fees (assessed need tiers that can add $500-1,500+ monthly), medication management, and one-time community or move-in fees are the big three. Always compare communities on the all-in monthly number at your parent's assessed level - base rent alone is a marketing figure.
Find senior care options near Boulder
These platforms show communities and home-care agencies near you with pricing guidance. Advisors are free to families - providers pay them, as they do this site.
Disclosure: this is an independent guide. If you connect with a provider through a link here, the platform may pay this site a referral fee. That fee never changes your price - and it never changes what the inspection records say.