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Montana - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Montana, Homemaker Services are funded through the state's 1915(c) Home and Community Based Services (HCBS) waivers, such as the Severe and Disabling Mental Illness (SDMI) waiver and the Big Sky Waiver. The service provides general household support, including meal preparation, laundry, shopping, and light housekeeping, for individuals who cannot perform these tasks independently. Providers must enroll with Montana Medicaid using HCBS code 28 for the provider type.

To become an approved provider, applicants must first meet the provider qualifications specified in the Provider Requirements Matrix for the respective waiver. The most significant structural precondition is that providers must be enrolled in the Montana Medicaid Program as an HCBS provider and meet all applicable state and federal statutes governing licensure and certification, though Homemaker Services themselves do not require a distinct facility license unless delivered by a licensed Home Health or Assisted Living agency.

1. Service Definition and Scope

Homemaker Services in Montana provide essential household assistance to waiver participants who are unable to manage these tasks due to their physical or mental health conditions. The service is designed to maintain a safe and healthy living environment, preventing institutionalization.

The scope of services typically includes routine household chores such as sweeping, mopping, dusting, laundry, meal preparation, and grocery shopping. It does not include personal care or hands-on medical assistance.

2. Regulatory and Oversight Agencies

The Montana Department of Public Health and Human Services (DPHHS) is the primary regulatory body overseeing HCBS waivers and Medicaid provider enrollment. Within DPHHS, specific divisions manage different waivers, such as the Behavioral Health and Disabilities Division (BHDD) for the SDMI waiver and the Senior & Long Term Care Division for the Big Sky Waiver.

Provider enrollment and claims processing are managed by the state's fiscal agent, Conduent, through the Montana Healthcare Programs Provider Information website and the Provider Services Portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

Montana does not impose a Certificate of Need or a closed network moratorium specifically for Homemaker Services. However, providers must meet the qualifications outlined in the specific waiver's Provider Requirements Matrix before their Medicaid enrollment application will be approved.

Independent contractors can enroll, but they must provide a copy of any applicable license, certification, or registration to the fiscal agent. Providers cannot be the member's spouse or, if the member is under 18, the natural, step, or adoptive parent, except under specific exceptions.

4. Licensure and Certification Requirements

Montana does not have a standalone "Homemaker Agency" license. Instead, providers must abide by all applicable state and federal statutes, regulations, and rules governing licensure and certification for their specific business type. If the homemaker service is provided by a licensed entity, such as a Home Health Agency or Assisted Living Facility, that license must be verified.

For independent contractors or agencies providing only homemaker services, standard business registration with the Montana Secretary of State is required, along with meeting the specific waiver qualifications.

5. Medicaid Provider Enrollment

All Homemaker Service providers must enroll as Montana Medicaid providers through the fiscal agent. The enrollment application must be completed in its entirety, using HCBS code 28 for the provider type.

The fiscal agent forwards completed enrollment forms to DPHHS for approval, assignment of procedure codes, and rates. Providers must also complete the ownership/control information section as required by CMS.

6. Staffing, Training and Background Checks

Staff providing Homemaker Services must meet the qualifications specified in the waiver's Provider Requirements Matrix. While specific training hours for homemakers are not universally mandated by a distinct license, agencies must ensure staff are competent to perform household tasks safely.

Providers are screened monthly against federal and state exclusion lists by the fiscal agent to ensure they are not prohibited from participating in Medicaid programs.

7. Documentation, Policies and Records

Providers must maintain documentation of their qualifications, copies of the provider participation agreement, Medicaid certification, and verification of any state licenses. All status changes, such as changes in ownership, address, or licensure, must be reported in writing to the fiscal agent immediately.

Service delivery must be documented to support claims billed to Medicaid, detailing the date, time, and specific tasks performed.

8. Billing, Rates and Claims

Upon enrollment, DPHHS authorizes procedure codes and rates based on provider qualifications and information from the Case Management Team (CMT). All SDMI HCBS waiver providers have a provider charge file in the Medicaid Management Information System (MMIS) that lists their approved codes and rates.

Claims are submitted electronically through the Provider Services Portal. Providers should check member eligibility, including Passport program status, prior to rendering services.

9. Approval Sequence and Timeline

The approval process begins with submitting a complete enrollment application to the fiscal agent. The fiscal agent verifies provider information and screens against exclusion lists.

Once verified, the application is forwarded to DPHHS for final approval and setup of the provider charge file. Providers receive a welcome letter containing their NPI or Atypical Provider Identifier (API) once enrollment is active.

10. Common Denials and Survey Findings

Enrollment applications are commonly delayed or denied if the form is incomplete, if ownership/control information is missing, or if the wrong provider type code is used. Claims will be denied if submitted before the enrollment is fully active or if billed for services ordered by a non-enrolled provider.

Failure to report changes in ownership or address 60 days prior to the active date can also result in claim denials or payments sent to the incorrect provider.

11. Key Contacts and Resources

Providers should utilize the Montana Healthcare Programs Provider Information website for manuals, fee schedules, and enrollment updates. The Provider Relations team is available to assist with enrollment and billing questions.

For waiver-specific policy questions, providers should contact the respective DPHHS division managing the waiver.

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