IDD Medicaid Rates in Montana: DDP Waiver Reimbursement (2026)

IDD Medicaid rates in Montana are set in a single document, the Developmental Disabilities Program Rates and Billing Manual, and most of them are priced per staff hour. Montana pays $44.75 per staff hour for in-home and community living supports on code H2015, against a national median of $34.92 an hour across 40 states. The one Montana IDD service that sits in the national hourly ranking, prevocational services, ranks 20th of 28 states at $12.13 an hour, 35% below the national median.

That split is the defining feature of Montana's schedule. Its core supports are priced on a staff-hour basis that reflects how many people a staff member supports, while prevocational work is priced per person-hour. Providers reading these numbers need to know which basis they are billing on before comparing them with other states.

Montana Medicaid IDD reimbursement: the staff-hour rates

Montana's Comprehensive Waiver, run by the Developmental Disabilities Program on a fee-for-service basis, publishes the following agency-provider rates, all effective July 1, 2025:

Two things stand out. First, Montana pays residential habilitation on the same $44.75 staff-hour rate as community living supports, rather than the daily per-person rate most states use. The national residential habilitation median of $280.27 a day is not directly comparable to that figure, so Montana does not appear in the residential ranking. Second, behavior support at $95.16 per staff hour is the highest-priced service on the schedule, consistent with the national pattern where behavior support carries the highest hourly median in IDD at $78.07.

H2015 Montana Medicaid rate in national context

For community living supports, the national picture runs from South Carolina at $85.96 an hour on T2017 down to Louisiana at $12.40. South Dakota ($69.28), Massachusetts ($68.04) and Alaska ($61.84) round out the top four; Idaho ($15.44) and West Virginia ($13.52) join Louisiana at the bottom.

Montana's $44.75 per staff hour sits above the $34.92 national median in raw dollars, but a staff-hour rate covers a staff member's time across everyone supported in that hour, so the per-person value depends on the staffing ratio written into the plan of care. Providers moving between Montana and a per-person state such as South Dakota should rebuild their cost model rather than compare headline rates.

Prevocational services: Montana's ranked rate

Prevocational services are the clearest direct comparison. Montana pays $12.13 an hour on T2015 with modifier UA, ranking 20th of 28 ranked states and sitting 35% below the national median of $18.67.

The national range is wide. Oregon pays $74.31 an hour, Minnesota $69.42 and Utah $60.68. California ($7.23), Indiana ($5.66) and the District of Columbia ($3.95) are lowest. Montana's rate is in the lower half but well above that bottom group. At $12.13 an hour, prevocational work in Montana only covers its staffing cost when one staff member supports a group, which is how most prevocational programs are run.

Direct support wages in Montana

Federal occupational wage data for May 2025 shows Montana's labor market for IDD providers:

• Direct support professional: $18.54 an hour in Montana versus $22.08 nationally (based on the closest comparable occupation)
• Residential advisor: $22.71 versus $20.31
• Home health and personal care aide: $17.61 versus $17.21
• Licensed practical nurse: $29.91 versus $30.96

The direct support wage is the one that matters most. Montana's median is well below the national figure, which means a $44.75 staff-hour rate goes further on wages here than the same dollar rate would in a higher-wage state. It also signals a recruiting problem: residential advisors in Montana earn more than the national median, so group-home operators compete for staff on a different footing than in-home support agencies do.

Prior authorization rules for Montana IDD codes

Montana's DDP codes carry a substantial number of prior authorization rules. Respite on S5100 has 18, while H0023 and H2021 each have 14. Residential supports on T2013 have 10, community living supports on H2015 have 8, supported employment on H2023 has 4, behavior support on H0046 has 3 and prevocational services on T2015 has 1.

In practice, that means authorization work concentrates on the services that carry the most revenue: residential and community living supports. Billing teams should match each claim to the authorized units and the plan of care before submission.

Recent DDP rate changes and the SFY2027 manual

Montana updates its IDD rates on a July 1 cycle through amendments to ARM 37.34.3005, the rule pertaining to the Rates and Billing Manual.

• SFY2026 final manual (effective July 1, 2025). A 3% increase across DDP waiver rates. This is the edition behind every rate on this page.
• MAR Notice No. 2025-129. Proposed November 7, 2025, with a supplemental notice on December 19, 2025, and adopted March 20, 2026, all with a July 1, 2025 effective date.
• SFY2027 draft manual (effective July 1, 2026). Proposed with a fractional reduction of less than one-tenth of one percent, which in practice holds rates flat.
• July 1, 2024 fee schedule updates. The prior annual edition.

For providers, the takeaway is stability: after a 3% increase for SFY2026, the SFY2027 draft essentially keeps the schedule where it is.

Managed care and Montana IDD services

Montana's IDD waiver is listed as a fee-for-service program, and the state's Medicaid plan landscape includes 17 plans and care-management arrangements such as Primary Care Montana tiers and Team Care. DDP waiver services themselves are billed against the published Rates and Billing Manual. The Montana managed care page lists the plans, and the Montana Medicaid rates hub covers the wider fee schedule.

For the cross-state view of every IDD service, see IDD Medicaid rates by state, and our methodology explains how staff-hour, daily and unit rates are compared.